Provider Demographics
NPI:1316370075
Name:BRAINTREE FAMILY DENTAL
Entity Type:Organization
Organization Name:BRAINTREE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT, BOARD OF DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HUY
Authorized Official - Middle Name:NHU
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:617-750-2021
Mailing Address - Street 1:381 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4741
Mailing Address - Country:US
Mailing Address - Phone:781-843-0340
Mailing Address - Fax:
Practice Address - Street 1:381 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4741
Practice Address - Country:US
Practice Address - Phone:781-843-0340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty