Provider Demographics
NPI:1033419668
Name:DENTAL DYNAMICS PC
Entity Type:Organization
Organization Name:DENTAL DYNAMICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-963-9200
Mailing Address - Street 1:16 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4114
Mailing Address - Country:US
Mailing Address - Phone:617-472-2143
Mailing Address - Fax:617-472-2143
Practice Address - Street 1:1110 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2132
Practice Address - Country:US
Practice Address - Phone:781-963-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN205441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty