Provider Demographics
NPI:1962626556
Name:NATICK COMMON DENTAL CENTER, P.C.
Entity Type:Organization
Organization Name:NATICK COMMON DENTAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDIENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINGJU
Authorized Official - Middle Name:JENNY
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-653-6771
Mailing Address - Street 1:19 COMMON ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4713
Mailing Address - Country:US
Mailing Address - Phone:508-653-6771
Mailing Address - Fax:508-653-5654
Practice Address - Street 1:19 COMMON ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4713
Practice Address - Country:US
Practice Address - Phone:508-653-6771
Practice Address - Fax:508-653-5654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA190681223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty