Provider Demographics
NPI:1831479971
Name:SHERBORN FAMILY DENTAL P.C.
Entity Type:Organization
Organization Name:SHERBORN FAMILY DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:LILY
Authorized Official - Middle Name:
Authorized Official - Last Name:LING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-654-0574
Mailing Address - Street 1:19 N MAIN ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:SHERBORN
Mailing Address - State:MA
Mailing Address - Zip Code:01770-1553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 N MAIN ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:SHERBORN
Practice Address - State:MA
Practice Address - Zip Code:01770-1553
Practice Address - Country:US
Practice Address - Phone:508-654-0574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-21
Last Update Date:2011-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty