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General NPI Number Information
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NPI Number | 1871987743
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Entity Type | Organization
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Legal Business Name | MIDDLESEX ADVANCED COSMETIC DENTISTRY, LLC
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Dates
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Enumeration Date | 03/27/2015
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Last Update Date | 03/27/2015
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Provider Practice Location Address
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Address Line | 955 MAIN ST SUITE 111
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City | WINCHESTER
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State | MA
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Zip | 01890-1961
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Country | US
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Telephone | 781-721-9900
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Fax | 781-721-9902
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Provider Business Mailing Address
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Address Line | 955 MAIN ST SUITE 111
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City | WINCHESTER
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State | MA
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Zip | 01890-1961
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Country | US
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Telephone | 781-721-9900
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Fax | 781-721-9902
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Authorized Official
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Title or Position | OWNER
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Name | DR. SOPHANA HEM
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Credential | DMD
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Telephone | 781-721-9900
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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 | DN22273
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License Number State | MA
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