Organization
MYSTIC VALLEY ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOY ELIZABETH KASPARIAN-FEDERICO D.M.D. (NA)
(781) 396-9230
Entity
Organization
Contact information
Practice address
80 HIGH ST, SUITE 2, MEDFORD, MA 02155-3872
(781) 396-9230
(781) 391-6090
Mailing address
80 HIGH ST, SUITE 2, MEDFORD, MA 02155-3872
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
19234
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0207021
—
MA
05
—
0209104
—
MA
Enumeration date
03/18/2008
Last updated
03/18/2008
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