Provider Demographics
NPI:1508741224
Name:IDG SPENCER DENTAL PLLC
Entity type:Organization
Organization Name:IDG SPENCER DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUNSOO
Authorized Official - Middle Name:
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-885-0033
Mailing Address - Street 1:134 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562-2621
Mailing Address - Country:US
Mailing Address - Phone:508-885-0033
Mailing Address - Fax:
Practice Address - Street 1:134 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-2621
Practice Address - Country:US
Practice Address - Phone:508-885-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty