Provider Demographics
NPI:1740050988
Name:MEDFORD FAMILY & COSMETIC DENTISTRY PLLC
Entity type:Organization
Organization Name:MEDFORD FAMILY & COSMETIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHUO
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-975-8413
Mailing Address - Street 1:7 AMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2201
Mailing Address - Country:US
Mailing Address - Phone:781-975-8413
Mailing Address - Fax:
Practice Address - Street 1:132 FOREST ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-2511
Practice Address - Country:US
Practice Address - Phone:781-396-8365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty