Provider Demographics
NPI:1003193939
Name:ACTON FAMILY DENTAL CARE, INC.
Entity Type:Organization
Organization Name:ACTON FAMILY DENTAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YAO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-263-7067
Mailing Address - Street 1:249 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-2804
Mailing Address - Country:US
Mailing Address - Phone:978-263-7067
Mailing Address - Fax:978-264-9737
Practice Address - Street 1:249 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-2804
Practice Address - Country:US
Practice Address - Phone:978-263-7067
Practice Address - Fax:978-264-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1043439490OtherNPI TYPE 1