| Phuongdao Dmd Llc | |
|
910 Broadway Fl 1 Everett MA 02149-3126 | |
| (617) 389-8317 | |
| Not Available |
| Full Name | Phuongdao Dmd Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 910 Broadway Fl 1, Everett, Massachusetts |
| Authorized Official Name and Position | Phuong Thi Dao (OWNER) |
| Authorized Official Contact | 6173898317 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phuongdao Dmd Llc 910 Broadway Fl 1 Everett MA 02149-3126 Ph: (617) 389-8317 | Phuongdao Dmd Llc 910 Broadway Fl 1 Everett MA 02149-3126 Ph: (617) 389-8317 |
| NPI Number | 1003176512 |
|---|---|
| Provider Enumeration Date | 05/18/2012 |
| Last Update Date | 05/18/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003176512 | NPI | - | NPPES |
| X06225 | Other | MA | BLUE CROSS BLUE SHIELD |
| 0276685 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 17573 (Massachusetts) | Primary |
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