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General NPI Number Information
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NPI Number | 1255463238
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Entity Type | Organization
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Legal Business Name | NANKIN DENTAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 500 CONGRESS ST SUITE 2D
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City | QUINCY
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State | MA
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Zip | 02169-0908
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Country | US
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Telephone | 617-471-9444
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Fax | 617-689-0183
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Provider Business Mailing Address
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Address Line | 500 CONGRESS ST SUITE 2D
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City | QUINCY
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State | MA
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Zip | 02169-0908
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Country | US
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Telephone | 617-471-9444
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Fax | 617-689-0183
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK IRA NANKIN
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Credential | D.D.S.
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Telephone | 617-471-9444
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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 | 13264
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License Number State | MA
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