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Organization
LAKEVILLE DENTAL ASSOCIATES, P.C.
Active
Organization
LAKEVILLE DENTAL ASSOCIATES, P.C.
Active
Other names
Lakeville Dental Associates, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHUONG PHAM D.M.D. (DENTIST)
(508) 923-6900
Entity
Organization
Contact information
Practice address
54 MAIN ST, SUITE 6, LAKEVILLE, MA 02347-3621
(508) 923-6900
(508) 946-0306
Mailing address
54 MAIN ST, SUITE 6, LAKEVILLE, MA 02347-3621
(508) 923-6900
(508) 946-0306
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
20826
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811540
UNITED CONCORDIA
MA
01
—
X12180
BCBS OF MA
MA
Enumeration date
02/21/2008
Last updated
02/21/2008
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