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General NPI Number Information
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NPI Number | 1609187475
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Entity Type | Individual
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Provider Name | AMY LI D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2010
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 145 SOUTH ST SOUTH COVE COMMUNITY HEALTH CENTER
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City | BOSTON
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State | MA
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Zip | 02111-2826
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Country | US
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Telephone | 617-521-6760
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Fax |
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Provider Business Mailing Address
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Address Line | 145 SOUTH ST SOUTH COVE COMMUNITY HEALTH CENTER
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City | BOSTON
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State | MA
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Zip | 02111-2826
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Country | US
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Telephone | 617-521-6760
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 1855750
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License Number State | MA
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