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General NPI Number Information
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NPI Number | 1447486600
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Entity Type | Organization
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Legal Business Name | PRIME DENTAL INC
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Dates
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Enumeration Date | 06/02/2009
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Last Update Date | 06/02/2009
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Provider Practice Location Address
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Address Line | 3112 CRANBERRY HWY
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City | EAST WAREHAM
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State | MA
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Zip | 02538-4804
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Country | US
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Telephone | 508-771-7753
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Fax | 508-771-7753
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Provider Business Mailing Address
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Address Line | 3112 CRANBERRY HWY
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City | EAST WAREHAM
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State | MA
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Zip | 02538-4804
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Country | US
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Telephone | 508-771-7751
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Fax | 508-771-7753
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANG J LEE
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Credential | DMD
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Telephone | 508-771-7751
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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 | 21084
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License Number State | MA
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