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General NPI Number Information
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NPI Number | 1952624751
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Entity Type | Organization
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Legal Business Name | STAFFORD DENTAL PC
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 03/08/2010
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Provider Practice Location Address
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Address Line | 450 HIGH ST
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City | FALL RIVER
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State | MA
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Zip | 02720-3345
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Country | US
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Telephone | 508-672-0924
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Fax | 508-672-0944
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Provider Business Mailing Address
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Address Line | 450 HIGH ST
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City | FALL RIVER
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State | MA
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Zip | 02720-3345
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Country | US
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Telephone | 508-672-0924
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Fax | 508-672-0944
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. SHENG HENG YU
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Credential | DMD
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Telephone | 508-672-0924
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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 | DN20597
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License Number State | MA
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