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General NPI Number Information
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NPI Number | 1962927103
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Entity Type | Organization
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Legal Business Name | WAYNE SHIM DMD LLC
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Dates
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Enumeration Date | 08/09/2017
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Last Update Date | 08/09/2017
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Provider Practice Location Address
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Address Line | 241 KING ST STE 220
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City | NORTHAMPTON
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State | MA
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Zip | 01060-2344
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Country | US
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Telephone | 413-586-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 13303 AVALON DR
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City | NORTHBOROUGH
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State | MA
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Zip | 01532-2173
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Country | US
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Telephone | 714-383-4516
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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. WAYNE SHIM
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Credential | DMD
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Telephone | 714-383-4516
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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 | 20756
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License Number State | MA
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