Provider Demographics
NPI:1053511782
Name:PIONEER DENTAL AT NEWTON CORNER, P.C.
Entity Type:Organization
Organization Name:PIONEER DENTAL AT NEWTON CORNER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PO-HSI
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-641-0005
Mailing Address - Street 1:269 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1612
Mailing Address - Country:US
Mailing Address - Phone:617-641-0005
Mailing Address - Fax:617-641-0006
Practice Address - Street 1:269 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1612
Practice Address - Country:US
Practice Address - Phone:617-641-0005
Practice Address - Fax:617-641-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty