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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