Provider Demographics
NPI:1437463312
Name:BROOKLINE ORTHODONTIC ASSOCIATES
Entity Type:Organization
Organization Name:BROOKLINE ORTHODONTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:YUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-686-0372
Mailing Address - Street 1:323 BOYLSTON ST # 2-104
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7600
Mailing Address - Country:US
Mailing Address - Phone:617-566-1775
Mailing Address - Fax:617-731-6131
Practice Address - Street 1:323 BOYLSTON ST # 2-104
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7600
Practice Address - Country:US
Practice Address - Phone:617-566-1775
Practice Address - Fax:617-731-6131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty