Healthcare Provider Details

I. General information

NPI: 1548863947
Provider Name (Legal Business Name): CENTRALMASSDENTALGROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 GROVE ST
ORANGE MA
01364-1009
US

IV. Provider business mailing address

9 GROVE ST
ORANGE MA
01364-1009
US

V. Phone/Fax

Practice location:
  • Phone: 978-544-3515
  • Fax:
Mailing address:
  • Phone: 978-544-3515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DONG WON KIM
Title or Position: OWNER
Credential: DMD
Phone: 617-888-3400