Healthcare Provider Details

I. General information

NPI: 1235058702
Provider Name (Legal Business Name): DENTISTS OF EAST BRIDGEWATER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 N BEDFORD ST UNIT 1
EAST BRIDGEWATER MA
02333-1123
US

IV. Provider business mailing address

567 N BEDFORD ST # 1
EAST BRIDGEWATER MA
02333-1123
US

V. Phone/Fax

Practice location:
  • Phone: 617-874-7197
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DANIEL JEEYONG HAN
Title or Position: OWNER/DENTIST
Credential:
Phone: 617-874-7197