Provider Demographics
NPI:1871034314
Name:NEW DENTAL28 PLLC
Entity Type:Organization
Organization Name:NEW DENTAL28 PLLC
Other - Org Name:DENTAL28
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:XINGXUE
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:HU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-863-5577
Mailing Address - Street 1:1725 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-5306
Mailing Address - Country:US
Mailing Address - Phone:781-863-5577
Mailing Address - Fax:781-372-1010
Practice Address - Street 1:1725 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-5306
Practice Address - Country:US
Practice Address - Phone:781-863-5577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223S0112X, 1223X2210X, 125Q00000X, 146N00000X
MADN1857061305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X2210XDental ProvidersDentistOrofacial PainGroup - Multi-Specialty
No125Q00000XDental ProvidersOral MedicinistGroup - Multi-Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1223G0001XOtherGENERAL PRACTICE IN DENTISTRY