Provider Demographics
NPI:1972916542
Name:SOUTHBOROUGH DENTISTRY PC
Entity Type:Organization
Organization Name:SOUTHBOROUGH DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HYUNG CHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-357-8800
Mailing Address - Street 1:21 TURNPIKE RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-2117
Mailing Address - Country:US
Mailing Address - Phone:508-357-8800
Mailing Address - Fax:
Practice Address - Street 1:21 TURNPIKE RD
Practice Address - Street 2:SUITE F
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-2117
Practice Address - Country:US
Practice Address - Phone:508-357-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty