1699824433 NPI number — 3-D DENTAL, PC

Table of content: (NPI 1699824433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699824433 NPI number — 3-D DENTAL, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
3-D DENTAL, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699824433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 MASSACHUSETTS AVE
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
ACTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01720-3739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-266-1288
Provider Business Mailing Address Fax Number:
978-266-1230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 MASSACHUSETTS AVE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
ACTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01720-3739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-266-1288
Provider Business Practice Location Address Fax Number:
978-266-1230
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WANG
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
WEI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-266-1288

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  19996 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 20540 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1306874292 . This is a "DENTIST" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1578591475 . This is a "DENTIST" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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