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Organization
WINCHESTER FAMILY DENTAL
Active
Organization
WINCHESTER FAMILY DENTAL
Active
Parent organization
BROADWAY DENTIST LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BROADWAY DENTIST LLC
Authorized official
HUI HUANG (OWNER)
(617) 694-1614
Entity
Organization
Contact information
Practice address
831 MAIN ST STE 2, WINCHESTER, MA 01890-1997
(617) 694-1614
Mailing address
831 MAIN ST STE 2, WINCHESTER, MA 01890-1997
(617) 694-1614
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
21366
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0205150
MASS HEALTH ID 0205150
MA
Enumeration date
01/27/2014
Last updated
01/27/2014
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