Healthcare Provider Details

I. General information

NPI: 1861747164
Provider Name (Legal Business Name): DENTAL SOLUTIONS OF NORTHBORO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 W MAIN ST
NORTHBOROUGH MA
01532-2100
US

IV. Provider business mailing address

367 W MAIN ST
NORTHBOROUGH MA
01532-2100
US

V. Phone/Fax

Practice location:
  • Phone: 508-393-4777
  • Fax: 508-393-3456
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number19087
License Number StateMA

VIII. Authorized Official

Name: DR. JASNA KUN
Title or Position: PRESIDENT
Credential: DMD
Phone: 508-393-4777