Healthcare Provider Details

I. General information

NPI: 1558682013
Provider Name (Legal Business Name): DAN HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 SOUTH ST
BOSTON MA
02111-2826
US

IV. Provider business mailing address

145 SOUTH ST
BOSTON MA
02111-2826
US

V. Phone/Fax

Practice location:
  • Phone: 617-521-6730
  • Fax:
Mailing address:
  • Phone: 617-521-6730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1855420
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: