| Blue Harbor Dental Pllc | |
|
332 Victory Rd Ste 3a Quincy MA 02171 | |
| (617) 953-2289 | |
| (617) 801-8180 |
| Full Name | Blue Harbor Dental Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 332 Victory Rd Ste 3a, Quincy, Massachusetts |
| Authorized Official Name and Position | Xiuping Wang (OWNER) |
| Authorized Official Contact | 6179532289 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Harbor Dental Pllc 332 Victory Rd Ste 3a Quincy MA 02171-3120 Ph: (617) 953-2289 | Blue Harbor Dental Pllc 332 Victory Rd Ste 3a Quincy MA 02171 Ph: (617) 953-2289 |
| NPI Number | 1700304425 |
|---|---|
| Provider Enumeration Date | 09/01/2017 |
| Last Update Date | 08/30/2023 |
| Medicare PECOS PAC ID | 3577918440 |
|---|---|
| Medicare Enrollment ID | O20231012001604 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700304425 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QS0112X | Clinic/center - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Xiuping Wang |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1891224465 PECOS PAC ID: 9830544717 Enrollment ID: I20231012001816 |
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