Provider Demographics
NPI:1356110472
Name:CENTRAL MASS DENTAL PLLC
Entity type:Organization
Organization Name:CENTRAL MASS DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YOON HWAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JEONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-914-2645
Mailing Address - Street 1:201 WESTFORD HILLS RD
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-2940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 W BROADWAY
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3480
Practice Address - Country:US
Practice Address - Phone:978-410-9664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty