Provider Demographics
NPI:1801260658
Name:ACCORD DENTAL PC
Entity type:Organization
Organization Name:ACCORD DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUNGWOO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-839-6464
Mailing Address - Street 1:1 HAWTHORNE ST # A
Mailing Address - Street 2:
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1292
Mailing Address - Country:US
Mailing Address - Phone:508-839-6464
Mailing Address - Fax:508-839-1445
Practice Address - Street 1:1 HAWTHORNE ST # A
Practice Address - Street 2:
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536-1292
Practice Address - Country:US
Practice Address - Phone:508-839-6464
Practice Address - Fax:508-839-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20719261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental