Provider Demographics
NPI:1851921365
Name:DUXBURY DENTAL CENTER PC
Entity Type:Organization
Organization Name:DUXBURY DENTAL CENTER PC
Other - Org Name:DUXBURY DENTAL CENTER PC
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HAN
Authorized Official - Middle Name:SOO
Authorized Official - Last Name:LHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-233-1189
Mailing Address - Street 1:347 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-2489
Mailing Address - Country:US
Mailing Address - Phone:781-233-1189
Mailing Address - Fax:
Practice Address - Street 1:40 TREMONT ST STE 58
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-5316
Practice Address - Country:US
Practice Address - Phone:781-233-1189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA21025OtherDENTIST