Healthcare Provider Details

I. General information

NPI: 1710043385
Provider Name (Legal Business Name): CHANDLER DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 02/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 CHANDLER ST SUITE 10
WORCESTER MA
01602-3300
US

IV. Provider business mailing address

372 CHANDLER ST SUITE 10
WORCESTER MA
01602-3300
US

V. Phone/Fax

Practice location:
  • Phone: 508-754-5226
  • Fax: 508-754-5228
Mailing address:
  • Phone: 508-754-5226
  • Fax: 508-754-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. SIR HAO FOO
Title or Position: TREASURER & SECRETARY
Credential: D.D.S., M.S.
Phone: 508-754-5226