Provider Demographics
NPI:1417141680
Name:MARLBORO ORTHODONTICS AND ASSOCIATES
Entity Type:Organization
Organization Name:MARLBORO ORTHODONTICS AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUN-YU
Authorized Official - Middle Name:YOGI
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-281-5188
Mailing Address - Street 1:340 MAPLE ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3200
Mailing Address - Country:US
Mailing Address - Phone:508-281-5188
Mailing Address - Fax:508-281-5190
Practice Address - Street 1:340 MAPLE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3200
Practice Address - Country:US
Practice Address - Phone:508-281-5188
Practice Address - Fax:508-281-5190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18640261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental