Healthcare Provider Details

I. General information

NPI: 1801468871
Provider Name (Legal Business Name): BOSTON EMBRACE ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2021
Last Update Date: 07/11/2021
Certification Date: 07/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 BEACON ST
NEWTON MA
02459-1822
US

IV. Provider business mailing address

831 BEACON ST # 263
NEWTON MA
02459-1822
US

V. Phone/Fax

Practice location:
  • Phone: 617-913-0532
  • Fax:
Mailing address:
  • Phone: 617-913-0532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JIE LIU
Title or Position: OWNER
Credential: DMD, M.S
Phone: 617-913-0532