Provider Demographics
NPI:1861500761
Name:COMPREHENSIVE DENTAL CARE
Entity Type:Organization
Organization Name:COMPREHENSIVE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:QUE
Authorized Official - Middle Name:THI
Authorized Official - Last Name:DINH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-288-7299
Mailing Address - Street 1:786 ADAMS STREET
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5134
Mailing Address - Country:US
Mailing Address - Phone:617-288-7299
Mailing Address - Fax:617-474-9771
Practice Address - Street 1:786 ADAMS STREET
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5134
Practice Address - Country:US
Practice Address - Phone:617-288-7299
Practice Address - Fax:617-474-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA185461223G0001X
MA198721223G0001X
MA210681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty