Provider Demographics
NPI:1134323975
Name:LUNG, DARRLY J (DMD)
Entity Type:Individual
Prefix:DR
First Name:DARRLY
Middle Name:J
Last Name:LUNG
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 1:60 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-2510
Mailing Address - Country:US
Mailing Address - Phone:617-423-6165
Mailing Address - Fax:617-426-0006
Practice Address - Street 1:60 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-2510
Practice Address - Country:US
Practice Address - Phone:617-423-6165
Practice Address - Fax:617-426-0006
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA166071223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1790838225OtherGROUP