Provider Demographics
NPI:1720178262
Name:ASHLAND FAMILY DENTAL PC
Entity Type:Organization
Organization Name:ASHLAND FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONGHEE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-881-7272
Mailing Address - Street 1:171 MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1187
Mailing Address - Country:US
Mailing Address - Phone:508-881-7272
Mailing Address - Fax:508-881-7274
Practice Address - Street 1:171 MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ASHLAND
Practice Address - State:MA
Practice Address - Zip Code:01721-1187
Practice Address - Country:US
Practice Address - Phone:508-881-7272
Practice Address - Fax:508-881-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11684OtherBC/BS
MA41980OtherHARVARD PILGRIM