Provider Demographics
NPI:1356455372
Name:MUN, SEUNGHEE L (DMD)
Entity Type:Individual
Prefix:
First Name:SEUNGHEE
Middle Name:L
Last Name:MUN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:S
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:245 COCHITUATE ROAD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701
Mailing Address - Country:US
Mailing Address - Phone:508-875-1060
Mailing Address - Fax:508-875-0620
Practice Address - Street 1:254 COCHITUATE RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4627
Practice Address - Country:US
Practice Address - Phone:508-875-1060
Practice Address - Fax:508-875-0620
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18131332B00000X
MA181311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX07438OtherBLUE CROSS BLUE SHIELD