Healthcare Provider Details

I. General information

NPI: 1982159299
Provider Name (Legal Business Name): Y. NATALIE JEONG, D.M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 LINCOLN RD
LINCOLN MA
01773-3834
US

IV. Provider business mailing address

160 LINCOLN RD P.O. BOX 262
LINCOLN MA
01773-3834
US

V. Phone/Fax

Practice location:
  • Phone: 781-259-1600
  • Fax: 781-259-1601
Mailing address:
  • Phone: 781-259-1600
  • Fax: 781-259-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number20074
License Number StateMA

VIII. Authorized Official

Name: DR. Y. NATALIE JEONG
Title or Position: OWNER
Credential:
Phone: 781-259-1600