| Prospect Dental Group, L.l.c. | |
|
30 Prospect St. Cambridge MA 02139 | |
| (617) 576-5300 | |
| (617) 576-5500 |
| Full Name | Prospect Dental Group, L.l.c. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 30 Prospect St., Cambridge, Massachusetts |
| Authorized Official Name and Position | Eugene Kyungmook Khang (OWNER) |
| Authorized Official Contact | 6175765300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prospect Dental Group, L.l.c. 30 Prospect St. Cambridge MA 02139 Ph: (617) 576-5300 | Prospect Dental Group, L.l.c. 30 Prospect St. Cambridge MA 02139 Ph: (617) 576-5300 |
| NPI Number | 1750521399 |
|---|---|
| Provider Enumeration Date | 02/23/2009 |
| Last Update Date | 07/10/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750521399 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 21214 (Massachusetts) | Primary |
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