Organization
CAMBRIDGE ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT NICHOLAS PETROSINO DMD MMSC (ADMINISTRATOR)
(617) 491-6800
Entity
Organization
Contact information
Practice address
1751 MASSACHUSETTS AVE, CAMBRIDGE, MA 02140-2218
(617) 491-6800
(617) 491-4424
Mailing address
1751 MASSACHUSETTS AVE, CAMBRIDGE, MA 02140-2218
(617) 491-6800
(617) 491-4424
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
14460
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0264482
INDIV MASS HEALTH NUMBER
—
05
—
9735119
—
MA
Enumeration date
08/10/2006
Last updated
08/22/2020
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