Organization
PHUONGDAO DMD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHUONG THI DAO D.M.D (OWNER)
(617) 389-8317
Entity
Organization
Contact information
Practice address
910 BROADWAY FL 1, EVERETT, MA 02149-3126
(617) 389-8317
Mailing address
910 BROADWAY FL 1, EVERETT, MA 02149-3126
(617) 389-8317
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
17573
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0276685
—
MA
01
—
X06225
BLUE CROSS BLUE SHIELD
MA
Enumeration date
05/18/2012
Last updated
05/18/2012
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