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General NPI Number Information
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NPI Number | 1275612228
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Entity Type | Individual
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Provider Name | CUONG DO DMD
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Gender | Male
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12 COLLEEN DR
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City | LAKEVILLE
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State | MA
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Zip | 02347-1663
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Country | US
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Telephone | 508-947-0111
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Fax | 508-947-9815
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Provider Business Mailing Address
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Address Line | 860 HARRISON AVE APT 912
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City | BOSTON
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State | MA
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Zip | 02118-4002
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Country | US
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Telephone | 508-947-0111
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Fax | 508-947-9815
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 21089
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License Number State | MA
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