Provider Demographics
NPI:1912439357
Name:UNITED DENTAL INC
Entity Type:Organization
Organization Name:UNITED DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANG
Authorized Official - Middle Name:JIN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-743-7888
Mailing Address - Street 1:3112 CRANBERRY HWY
Mailing Address - Street 2:UNIT A
Mailing Address - City:EAST WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02538-4810
Mailing Address - Country:US
Mailing Address - Phone:508-743-7888
Mailing Address - Fax:888-594-4555
Practice Address - Street 1:131 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1723
Practice Address - Country:US
Practice Address - Phone:508-743-7888
Practice Address - Fax:888-594-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21084261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0206946Medicaid