Healthcare Provider Details

I. General information

NPI: 1346091899
Provider Name (Legal Business Name): TIM HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 BROADWAY
EVERETT MA
02149-3128
US

IV. Provider business mailing address

948 BROADWAY
EVERETT MA
02149-3128
US

V. Phone/Fax

Practice location:
  • Phone: 617-294-4128
  • Fax:
Mailing address:
  • Phone: 617-294-4129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10001134
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: