Healthcare Provider Details

I. General information

NPI: 1548960206
Provider Name (Legal Business Name): WILLIAM JIN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 PROVIDENCE HWY
DEDHAM MA
02026-1809
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1049
US

V. Phone/Fax

Practice location:
  • Phone: 781-461-0666
  • Fax:
Mailing address:
  • Phone: 319-356-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10001199
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: