Healthcare Provider Details

I. General information

NPI: 1871034314
Provider Name (Legal Business Name): NEW DENTAL28 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 MASSACHUSETTS AVE
LEXINGTON MA
02420-5306
US

IV. Provider business mailing address

1725 MASSACHUSETTS AVE
LEXINGTON MA
02420-5306
US

V. Phone/Fax

Practice location:
  • Phone: 781-863-5577
  • Fax:
Mailing address:
  • Phone: 781-863-5577
  • Fax: 781-372-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code125Q00000X
TaxonomyOral Medicine Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberDN1857061
License Number StateMA

VIII. Authorized Official

Name: DR. XINGXUE HARRY HU
Title or Position: DIRECTOR
Credential: D.M.D.
Phone: 781-863-5577