Provider Demographics
NPI:1871261347
Name:ADVANCED WALTHAM DENTAL
Entity type:Organization
Organization Name:ADVANCED WALTHAM DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-366-0411
Mailing Address - Street 1:100 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-4439
Mailing Address - Country:US
Mailing Address - Phone:781-366-0411
Mailing Address - Fax:
Practice Address - Street 1:100 MAPLE ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-4439
Practice Address - Country:US
Practice Address - Phone:781-366-0411
Practice Address - Fax:781-810-4811
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED CROWN DENTAL P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty