Provider Demographics
NPI:1356653174
Name:NAUSET BEACH DENTAL INC
Entity Type:Organization
Organization Name:NAUSET BEACH DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-255-1401
Mailing Address - Street 1:16 BEACH RD
Mailing Address - Street 2:
Mailing Address - City:E ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02643-0637
Mailing Address - Country:US
Mailing Address - Phone:508-255-1401
Mailing Address - Fax:
Practice Address - Street 1:16 BEACH RD.
Practice Address - Street 2:
Practice Address - City:E. ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02643-0637
Practice Address - Country:US
Practice Address - Phone:508-255-1401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18834305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service