Healthcare Provider Details

I. General information

NPI: 1417974106
Provider Name (Legal Business Name): FOXBORO DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 CENTRAL ST UNIT #103
FOXBORO MA
02035-2433
US

IV. Provider business mailing address

132 CENTRAL STREET UNIT #103
FOXBORO MA
02035
US

V. Phone/Fax

Practice location:
  • Phone: 508-543-7901
  • Fax: 508-543-3147
Mailing address:
  • Phone: 508-543-7901
  • Fax: 508-543-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number21317
License Number StateMA

VIII. Authorized Official

Name: DR. VICTOR LEUNG
Title or Position: PRESIDENT
Credential: DMD
Phone: 508-543-7901