Provider Demographics
NPI:1053529701
Name:CONCORD-CARLISLE DENTAL ASSOCIATES, PC
Entity type:Organization
Organization Name:CONCORD-CARLISLE DENTAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BJORNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-369-3088
Mailing Address - Street 1:290 BAKER AVE
Mailing Address - Street 2:SUITE 201 SOUTH
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2189
Mailing Address - Country:US
Mailing Address - Phone:978-369-3088
Mailing Address - Fax:
Practice Address - Street 1:290 BAKER AVE
Practice Address - Street 2:SUITE 201 SOUTH
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2189
Practice Address - Country:US
Practice Address - Phone:978-369-3088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty