Provider Demographics
NPI:1306203971
Name:UNION DENTAL RANDOLPH LLC
Entity Type:Organization
Organization Name:UNION DENTAL RANDOLPH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:HAOYU
Authorized Official - Last Name:TONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-888-4672
Mailing Address - Street 1:117 SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3181
Mailing Address - Country:US
Mailing Address - Phone:617-888-4672
Mailing Address - Fax:
Practice Address - Street 1:1110 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2132
Practice Address - Country:US
Practice Address - Phone:781-963-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TONY TONG PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty