Provider Demographics
NPI:1780008755
Name:NORWOOD FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:NORWOOD FAMILY DENTAL PLLC
Other - Org Name:NORWOOD FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LI
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-769-0818
Mailing Address - Street 1:117 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3557
Mailing Address - Country:US
Mailing Address - Phone:781-769-0818
Mailing Address - Fax:
Practice Address - Street 1:117 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3557
Practice Address - Country:US
Practice Address - Phone:781-769-0818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty