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Organization
MI DENTAL, LLC
Active
Organization
MI DENTAL, LLC
Active
Other names
Leather District Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE VO DMD (PEDIATRIC DENTIST)
(617) 306-4449
Entity
Organization
Contact information
Practice address
180 LINCOLN ST STE 2, BOSTON, MA 02111-2400
(617) 338-0833
Mailing address
180 LINCOLN ST STE 2, BOSTON, MA 02111-2400
(617) 338-0833
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110022129G
—
MA
Enumeration date
04/12/2021
Last updated
04/12/2021
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