Healthcare Provider Details

I. General information

NPI: 1710177696
Provider Name (Legal Business Name): EXCELL FAMILY DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 FURNACE BROOK PKWY #24
QUINCY MA
02169-4721
US

IV. Provider business mailing address

1261 FURNACE BROOK PKWY #24
QUINCY MA
02169-4721
US

V. Phone/Fax

Practice location:
  • Phone: 617-471-6970
  • Fax:
Mailing address:
  • Phone: 617-471-6970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. HEIDI HUANG
Title or Position: PRESIDENT
Credential: D.M.D
Phone: 617-953-6364