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General NPI Number Information
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NPI Number | 1568788396
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Entity Type | Organization
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Legal Business Name | WAYLAND ORAL SURGERY, P.C.
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Dates
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Enumeration Date | 04/19/2010
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Last Update Date | 04/19/2010
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Provider Practice Location Address
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Address Line | 241 BOSTON POST RD SUITE 2
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City | WAYLAND
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State | MA
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Zip | 01778-1836
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Country | US
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Telephone | 203-889-8916
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Fax |
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Provider Business Mailing Address
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Address Line | 241 BOSTON POST RD SUITE 2
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City | WAYLAND
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State | MA
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Zip | 01778-1836
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Country | US
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Telephone | 203-889-8916
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YONG-HAN KOO
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Credential | D.D.S.
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Telephone | 203-889-8916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | DN22058
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License Number State | MA
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