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General NPI Number Information
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NPI Number | 1700304425
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Entity Type | Organization
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Legal Business Name | BLUE HARBOR DENTAL PLLC
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Dates
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Enumeration Date | 09/01/2017
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 332 VICTORY RD STE 3A
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City | QUINCY
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State | MA
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Zip | 02171
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Country | US
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Telephone | 617-953-2289
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Fax | 617-801-8180
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Provider Business Mailing Address
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Address Line | 332 VICTORY RD STE 3A
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City | QUINCY
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State | MA
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Zip | 02171-3120
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Country | US
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Telephone | 617-953-2289
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Fax | 617-801-8180
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Authorized Official
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Title or Position | OWNER
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Name | DR. XIUPING WANG
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Credential | DMD
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Telephone | 617-953-2289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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License Number State |
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