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General NPI Number Information
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NPI Number | 1073172243
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Entity Type | Organization
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Legal Business Name | BLUE SKY FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1 BILLINGS RD STE 101
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City | QUINCY
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State | MA
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Zip | 02171-2456
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Country | US
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Telephone | 781-654-7213
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Fax |
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Provider Business Mailing Address
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Address Line | 131 HOBART ST
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City | BRAINTREE
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State | MA
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Zip | 02184-2123
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER - DENTIST
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Name | AMY LI
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Credential | DMD
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Telephone | 646-824-5176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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