Provider Demographics
NPI:1255463238
Name:NANKIN DENTAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:NANKIN DENTAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:NANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-471-9444
Mailing Address - Street 1:500 CONGRESS ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0908
Mailing Address - Country:US
Mailing Address - Phone:617-471-9444
Mailing Address - Fax:617-689-0183
Practice Address - Street 1:500 CONGRESS ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0908
Practice Address - Country:US
Practice Address - Phone:617-471-9444
Practice Address - Fax:617-689-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty