Healthcare Provider Details

I. General information

NPI: 1013218411
Provider Name (Legal Business Name): TNT DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAIN ST
WATERTOWN MA
02472-4301
US

IV. Provider business mailing address

230 MAIN ST
WATERTOWN MA
02472-4301
US

V. Phone/Fax

Practice location:
  • Phone: 617-923-0088
  • Fax: 617-926-2598
Mailing address:
  • Phone: 617-923-0088
  • Fax: 617-926-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21400
License Number StateMA

VIII. Authorized Official

Name: DR. TRACEY PHUONG LAI
Title or Position: OWNER
Credential: DMD
Phone: 617-923-0088