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General NPI Number Information
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NPI Number | 1013218411
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Entity Type | Organization
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Legal Business Name | TNT DENTAL CARE
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 230 MAIN ST
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City | WATERTOWN
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State | MA
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Zip | 02472-4301
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Country | US
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Telephone | 617-923-0088
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Fax | 617-926-2598
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Provider Business Mailing Address
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Address Line | 230 MAIN ST
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City | WATERTOWN
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State | MA
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Zip | 02472-4301
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Country | US
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Telephone | 617-923-0088
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Fax | 617-926-2598
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRACEY PHUONG LAI
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Credential | DMD
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Telephone | 617-923-0088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 21400
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License Number State | MA
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