Provider Demographics
NPI:1366692824
Name:THE DENTAL COLLABORATIVE, P.C.
Entity type:Organization
Organization Name:THE DENTAL COLLABORATIVE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:YAT SING
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-338-0833
Mailing Address - Street 1:PO BOX 120136
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02112-0136
Mailing Address - Country:US
Mailing Address - Phone:617-338-0833
Mailing Address - Fax:
Practice Address - Street 1:180 LINCOLN ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-2400
Practice Address - Country:US
Practice Address - Phone:617-338-0833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17958261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental