Provider Demographics
NPI:1205220134
Name:SAMOSET FAMILY DENTAL, P.C.
Entity Type:Organization
Organization Name:SAMOSET FAMILY DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIANGYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-746-4456
Mailing Address - Street 1:159 SAMOSET ST
Mailing Address - Street 2:STE 5
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4815
Mailing Address - Country:US
Mailing Address - Phone:508-746-4456
Mailing Address - Fax:
Practice Address - Street 1:159 SAMOSET ST
Practice Address - Street 2:STE 5
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4815
Practice Address - Country:US
Practice Address - Phone:508-746-4456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-28
Last Update Date:2015-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855730122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty