Provider Demographics
NPI:1871917997
Name:SOUTHERN MASSACHUSETTS DENTAL, P.C.
Entity type:Organization
Organization Name:SOUTHERN MASSACHUSETTS DENTAL, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:PHUONG
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:774-213-9178
Mailing Address - Street 1:54 MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-3621
Mailing Address - Country:US
Mailing Address - Phone:508-923-6900
Mailing Address - Fax:
Practice Address - Street 1:54 MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-3621
Practice Address - Country:US
Practice Address - Phone:508-923-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental