Provider Demographics
NPI:1952563348
Name:FRANK T M NGHIEM D.M.D.,P.C
Entity type:Organization
Organization Name:FRANK T M NGHIEM D.M.D.,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEMT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGHIEM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-288-7600
Mailing Address - Street 1:1510 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1327
Mailing Address - Country:US
Mailing Address - Phone:617-288-7600
Mailing Address - Fax:
Practice Address - Street 1:1510 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1327
Practice Address - Country:US
Practice Address - Phone:617-288-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA266795Medicaid