Provider Demographics
NPI:1003016429
Name:HUA, SALLY (DMD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:HUA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-2108
Mailing Address - Country:US
Mailing Address - Phone:781-340-5437
Mailing Address - Fax:781-340-5438
Practice Address - Street 1:5 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-2108
Practice Address - Country:US
Practice Address - Phone:781-340-5437
Practice Address - Fax:781-340-5438
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18552051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry