Provider Demographics
NPI:1922652767
Name:LEXINGTON DENTAL GROUP LLC
Entity Type:Organization
Organization Name:LEXINGTON DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:J
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-562-0457
Mailing Address - Street 1:500 CHAPMAN ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2040
Mailing Address - Country:US
Mailing Address - Phone:781-562-0457
Mailing Address - Fax:
Practice Address - Street 1:35 BEDFORD ST STE 16
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4440
Practice Address - Country:US
Practice Address - Phone:781-863-0096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty