Provider Demographics
NPI:1114262367
Name:DENTAL PLUS, P.C.
Entity Type:Organization
Organization Name:DENTAL PLUS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-752-1111
Mailing Address - Street 1:11 TOBIAS BOLAND WAY
Mailing Address - Street 2:UNIT #105
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01607-2108
Mailing Address - Country:US
Mailing Address - Phone:508-752-1111
Mailing Address - Fax:
Practice Address - Street 1:11 TOBIAS BOLAND WAY
Practice Address - Street 2:UNIT #105
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01607-2108
Practice Address - Country:US
Practice Address - Phone:508-752-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN215971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty