Healthcare Provider Details

I. General information

NPI: 1245327469
Provider Name (Legal Business Name): FAMILY DENTAL HEALTH CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BILLINGS RD
NORTH QUINCY MA
02171-2336
US

IV. Provider business mailing address

121 BILLINGS RD
NORTH QUINCY MA
02171-2336
US

V. Phone/Fax

Practice location:
  • Phone: 617-328-5577
  • Fax: 617-328-9691
Mailing address:
  • Phone: 617-328-5577
  • Fax: 617-328-9691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KUN ZHAO
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 617-328-5577