Provider Demographics
NPI:1811542400
Name:QUINCY DENTAL SPECIALISTS GROUP LLC
Entity type:Organization
Organization Name:QUINCY DENTAL SPECIALISTS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:XIAO
Authorized Official - Middle Name:
Authorized Official - Last Name:DONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-328-5060
Mailing Address - Street 1:580 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-1909
Mailing Address - Country:US
Mailing Address - Phone:617-328-5060
Mailing Address - Fax:
Practice Address - Street 1:580 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-1909
Practice Address - Country:US
Practice Address - Phone:617-328-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty