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General NPI Number Information
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NPI Number | 1588865349
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Entity Type | Organization
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Legal Business Name | JOHN T. TIEU D.M.D, P.C.
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 ALLSTATE RD SUITE 107
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City | DORCHESTER
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State | MA
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Zip | 02125-1641
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Country | US
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Telephone | 617-442-2535
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Fax |
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Provider Business Mailing Address
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Address Line | 101 ALLSTATE RD SUITE 107
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City | DORCHESTER
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State | MA
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Zip | 02125-1641
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Country | US
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Telephone | 617-442-2535
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JOHN T TIEU
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Credential | DMD
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Telephone | 617-442-2535
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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 | 20059
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License Number State | MA
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