Healthcare Provider Details

I. General information

NPI: 1417405424
Provider Name (Legal Business Name): LI ZHONG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SACK BLVD
LEOMINSTER MA
01453-3325
US

IV. Provider business mailing address

404 SARGENT RD
BOXBOROUGH MA
01719-1206
US

V. Phone/Fax

Practice location:
  • Phone: 978-466-6800
  • Fax:
Mailing address:
  • Phone: 352-562-4921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1857415
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: