| Organization Name: | WILBRAHAM ORTHODONTICS PC |
| NPI Number: | 1114362738 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL MARGOLIS (PRESIDENT) |
| Mailing Address: | 3 Crane Park Dr Wilbraham |
| State: | MA US |
| Postal Code: | 010951787 |
| Phone Number: | 4135969657 |
| Fax Number: | |
| NPI Enumeration Date: | 05/09/2013 |
| NPI Last Update Date: | 05/09/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 19247 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |