Healthcare Provider Details

I. General information

NPI: 1922156082
Provider Name (Legal Business Name): CHIH-MING KO D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 BOSTON RD
NORTH BILLERICA MA
01862-2328
US

IV. Provider business mailing address

199 BOSTON RD
NORTH BILLERICA MA
01862-2328
US

V. Phone/Fax

Practice location:
  • Phone: 978-439-0155
  • Fax:
Mailing address:
  • Phone: 978-439-0155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number17372
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: