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General NPI Number Information
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NPI Number | 1679747398
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Entity Type | Organization
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Legal Business Name | BAY STATE ORAL SURGERY ASSOCIATES, INC.
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 02/23/2009
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Provider Practice Location Address
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Address Line | 9 LINDEN STREET
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City | WORCESTER
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State | MA
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Zip | 01609
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Country | US
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Telephone | 508-755-0008
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Fax | 508-770-0603
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Provider Business Mailing Address
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Address Line | 9 LINDEN STREET
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City | WORCESTER
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State | MA
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Zip | 01609
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Country | US
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Telephone | 508-755-0008
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Fax | 508-770-0603
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Authorized Official
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Title or Position | PRESIDENT
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Name | XUE YU SHEN
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Credential | DMD
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Telephone | 508-755-0008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 10436
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 21007
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License Number State | MA
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