Healthcare Provider Details

I. General information

NPI: 1073207577
Provider Name (Legal Business Name): CHING-SHUAN HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 11/26/2024
Certification Date: 11/21/2024
Deactivation Date: 01/08/2024
Reactivation Date: 11/12/2024

III. Provider practice location address

HARVARD DENTAL CENTER 188 LONGWOOD AVE.
BOSTON MA
02115
US

IV. Provider business mailing address

HARVARD DENTAL CENTER 188 LONGWOOD AVE.
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-432-1434
  • Fax: 617-432-4258
Mailing address:
  • Phone: 617-432-1434
  • Fax: 617-432-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL100143
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: