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Organization
CENTER FOR DENTAL MEDICINE & RECONSTRUCTION
Active
Organization
CENTER FOR DENTAL MEDICINE & RECONSTRUCTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. QUINN CHAN DMD (OWNER/MANAGER)
(781) 728-5455
Entity
Organization
Contact information
Practice address
152 LINCOLN RD STE 1, LINCOLN, MA 01773-3832
(781) 728-5455
Mailing address
32 TRAVELER ST UNIT 510, BOSTON, MA 02118-2840
(617) 851-5463
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669663886
—
MA
05
—
1821365479
—
MA
Enumeration date
04/23/2019
Last updated
04/23/2019
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