Provider Demographics
NPI:1275076598
Name:J&W DENTAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:J&W DENTAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:XIAOZHE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-838-2188
Mailing Address - Street 1:65 HARRISON AVE
Mailing Address - Street 2:SUITE 508
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1924
Mailing Address - Country:US
Mailing Address - Phone:617-338-9727
Mailing Address - Fax:
Practice Address - Street 1:65 HARRISON AVE
Practice Address - Street 2:SUITE 508
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1924
Practice Address - Country:US
Practice Address - Phone:617-338-9727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22167261QD0000X
MA21577261QD0000X
MA18785261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental