Provider Demographics
NPI:1477860229
Name:XUAN DUONG, DMD LLC
Entity Type:Organization
Organization Name:XUAN DUONG, DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:XUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-854-1714
Mailing Address - Street 1:548 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3549
Mailing Address - Country:US
Mailing Address - Phone:781-854-1714
Mailing Address - Fax:
Practice Address - Street 1:724 CHELMSFORD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-5157
Practice Address - Country:US
Practice Address - Phone:781-854-1714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN22286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty