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1318 Beacon St Ste 1 Brookline MA 02446 | |
| (857) 858-0246 | |
| (857) 858-0345 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1318 Beacon St Ste 1, Brookline, Massachusetts |
| Authorized Official Name and Position | Soo Jin Lee (PRACTICE OWNER) |
| Authorized Official Contact | 8578580246 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1443 Beacon St Apt 706 Brookline MA 02446-4712 Ph: (678) 677-1578 | 1318 Beacon St Ste 1 Brookline MA 02446 Ph: (857) 858-0246 |
| NPI Number | 1396581096 |
|---|---|
| Provider Enumeration Date | 07/02/2024 |
| Last Update Date | 11/09/2024 |
| Medicare PECOS PAC ID | 1658810288 |
|---|---|
| Medicare Enrollment ID | O20240828000199 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396581096 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X2210X | Dentist - Orofacial Pain | (* (Not Available)) | Primary |
| Provider Name | Soo Jin Lee |
|---|---|
| Provider Type | Practitioner - Orofacial Pain |
| Provider Identifiers | NPI Number: 1518451103 PECOS PAC ID: 8820447568 Enrollment ID: I20240828000295 |
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