Provider Demographics
NPI:1083226187
Name:CHELMSFORD DENTAL CARE LLC
Entity Type:Organization
Organization Name:CHELMSFORD DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-669-2654
Mailing Address - Street 1:3 COURTHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1722
Mailing Address - Country:US
Mailing Address - Phone:978-970-2089
Mailing Address - Fax:978-970-2087
Practice Address - Street 1:3 COURTHOUSE LN
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1722
Practice Address - Country:US
Practice Address - Phone:978-970-2089
Practice Address - Fax:978-970-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental