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General NPI Number Information
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NPI Number | 1710303201
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Entity Type | Organization
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Legal Business Name | WALNUT DENTAL GROUP
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Dates
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Enumeration Date | 03/09/2014
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Last Update Date | 03/09/2014
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Provider Practice Location Address
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Address Line | 235 WALNUT ST # S1
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City | FRAMINGHAM
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State | MA
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Zip | 01702-7592
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Country | US
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Telephone | 508-416-6118
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Fax |
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Provider Business Mailing Address
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Address Line | 235 WALNUT ST # S1
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City | FRAMINGHAM
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State | MA
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Zip | 01702-7592
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Country | US
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Telephone |
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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. JUNGMEE YOUN
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Credential |
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Telephone | 508-416-6118
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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 | DN22130
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License Number State | MA
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