MEDICARE: JR DENTAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1649841776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JR DENTAL PLLC

Provider Business Mailing Address
First Line	:	4 MYRNA RD
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-1810
Country	:	US
Telephone Number	:	617-794-1416
Fax Number	:

Provider Business Practice Location Address
First Line	:	1732 MAIN ST UNIT C-1B
Second Line	:
City	:	CONCORD
State	:	MA
Zip	:	01742-3837
Country	:	US
Telephone Number	:	617-794-1416
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	RUOXI DAI
Credential	:
Telephone Number	:	858-282-9292

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	07/09/2021

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Directions to “JR DENTAL PLLC ” Practice Location

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