Provider Demographics
NPI:1194025015
Name:EMERSON DENTAL PC
Entity Type:Organization
Organization Name:EMERSON DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MUNG-HAN
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-399-0017
Mailing Address - Street 1:133 LITTLETON RD
Mailing Address - Street 2:SUITE #203
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3115
Mailing Address - Country:US
Mailing Address - Phone:978-399-0017
Mailing Address - Fax:978-399-0018
Practice Address - Street 1:133 LITTLETON RD
Practice Address - Street 2:SUITE #203
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3115
Practice Address - Country:US
Practice Address - Phone:978-399-0017
Practice Address - Fax:978-399-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21384122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty