Provider Demographics
NPI:1982159299
Name:Y. NATALIE JEONG, D.M.D., P.C.
Entity Type:Organization
Organization Name:Y. NATALIE JEONG, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:Y. NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-259-1600
Mailing Address - Street 1:160 LINCOLN RD
Mailing Address - Street 2:P.O. BOX 262
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-3834
Mailing Address - Country:US
Mailing Address - Phone:781-259-1600
Mailing Address - Fax:781-259-1601
Practice Address - Street 1:160 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:MA
Practice Address - Zip Code:01773-3834
Practice Address - Country:US
Practice Address - Phone:781-259-1600
Practice Address - Fax:781-259-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200741223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty