Provider Demographics
NPI:1609911569
Name:DESJARDINS MANAGEMENT INC.
Entity type:Organization
Organization Name:DESJARDINS MANAGEMENT INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILIAN
Authorized Official - Middle Name:CORALIA
Authorized Official - Last Name:DESJARDINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-682-4525
Mailing Address - Street 1:420 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1214
Mailing Address - Country:US
Mailing Address - Phone:978-682-4525
Mailing Address - Fax:978-691-5069
Practice Address - Street 1:420 ESSEX ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1214
Practice Address - Country:US
Practice Address - Phone:978-682-4525
Practice Address - Fax:978-691-5069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty