MEDICARE: ZHAN HUANG D.M.D., PH.D.

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	122300000X	Dentist	DN1857412	MA

General Provider Information

NPI Number	:	1760938344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZHAN HUANG D.M.D., PH.D.

Provider Business Mailing Address
First Line	:	350 N CLARK ST FL 6
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-4712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 STAFFORD ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01603-1450
Country	:	US
Telephone Number	:	508-770-0900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	09/01/2016

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