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General NPI Number Information
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NPI Number | 1457894321
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Entity Type | Organization
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Legal Business Name | DENTISTAR PC
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 11/28/2016
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Provider Practice Location Address
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Address Line | 205 HARVARD AVE
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City | ALLSTON
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State | MA
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Zip | 02134-4617
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Country | US
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Telephone | 617-396-8966
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Fax |
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Provider Business Mailing Address
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Address Line | 205 HARVARD AVE
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City | ALLSTON
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State | MA
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Zip | 02134-4617
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Country | US
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Telephone | 617-396-8966
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HYUNG CHAN CHO
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Credential |
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Telephone | 857-753-6915
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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 | DN21696
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License Number State | MA
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