Provider Demographics
NPI:1831877851
Name:SUDBURY DENTAL ASSOCIATES
Entity type:Organization
Organization Name:SUDBURY DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YALI
Authorized Official - Middle Name:
Authorized Official - Last Name:LOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-686-8254
Mailing Address - Street 1:25 TRUMAN RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3058
Practice Address - Country:US
Practice Address - Phone:617-686-8254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental