Provider Demographics
NPI:1679347876
Name:DENTAL TREE LLC
Entity Type:Organization
Organization Name:DENTAL TREE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:SHU
Authorized Official - Middle Name:
Authorized Official - Last Name:DENG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-331-3701
Mailing Address - Street 1:3 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6295
Mailing Address - Country:US
Mailing Address - Phone:617-331-3701
Mailing Address - Fax:
Practice Address - Street 1:3 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6295
Practice Address - Country:US
Practice Address - Phone:617-331-3701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental