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General NPI Number Information
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NPI Number | 1912439357
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Entity Type | Organization
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Legal Business Name | UNITED DENTAL INC
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 131 MERRIMACK ST
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City | LOWELL
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State | MA
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Zip | 01852-1723
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Country | US
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Telephone | 508-743-7888
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Fax | 888-594-4555
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Provider Business Mailing Address
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Address Line | 3112 CRANBERRY HWY UNIT A
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City | EAST WAREHAM
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State | MA
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Zip | 02538-4810
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Country | US
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Telephone | 508-743-7888
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Fax | 888-594-4555
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Authorized Official
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Title or Position | OWNER
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Name | SANG JIN LEE
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Credential | D.M.D
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Telephone | 508-743-7888
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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 | 21084
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License Number State | MA
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