Provider Demographics
NPI:1801468871
Name:BOSTON EMBRACE ORTHODONTICS
Entity type:Organization
Organization Name:BOSTON EMBRACE ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:617-913-0532
Mailing Address - Street 1:831 BEACON ST # 263
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1822
Mailing Address - Country:US
Mailing Address - Phone:617-913-0532
Mailing Address - Fax:
Practice Address - Street 1:833 BEACON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1822
Practice Address - Country:US
Practice Address - Phone:617-913-0532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-11
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty