Provider Demographics
NPI:1023856374
Name:NORTHERN LIGHT DENTAL, PLLC
Entity type:Organization
Organization Name:NORTHERN LIGHT DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:CHUYEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-671-9607
Mailing Address - Street 1:3000 PRESIDENTS WAY APT 3211
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4579
Mailing Address - Country:US
Mailing Address - Phone:617-671-9607
Mailing Address - Fax:
Practice Address - Street 1:648 WASHINGTON ST STE 204
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3575
Practice Address - Country:US
Practice Address - Phone:781-551-0235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty