Provider Demographics
NPI:1083870687
Name:HEM, SOPHANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SOPHANA
Middle Name:
Last Name:HEM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 MAIN ST
Mailing Address - Street 2:SUITE #111
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1961
Mailing Address - Country:US
Mailing Address - Phone:781-721-9900
Mailing Address - Fax:781-721-9902
Practice Address - Street 1:955 MAIN ST
Practice Address - Street 2:SUITE #111
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1961
Practice Address - Country:US
Practice Address - Phone:781-721-9900
Practice Address - Fax:781-721-9902
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-03
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222731223G0001X
MADN222731223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics