Healthcare Provider Details

I. General information

NPI: 1700589470
Provider Name (Legal Business Name): CAMBRIDGE ORAL SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 MASSACHUSETTS AVE
CAMBRIDGE MA
02140-1252
US

IV. Provider business mailing address

7 MYSTIC VIEW TER
ARLINGTON MA
02474-1245
US

V. Phone/Fax

Practice location:
  • Phone: 617-319-3917
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. JINGYI HE
Title or Position: OWNER
Credential: DMD
Phone: 617-319-3917