Organization
JL DENTAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN JUNGHO LEE DMD (SOLE PROPRIETOR)
(617) 327-1350
Entity
Organization
Contact information
Practice address
1892 CENTRE ST, WEST ROXBURY, MA 02132-1924
(617) 327-1350
(617) 327-1573
Mailing address
1892 CENTRE ST, WEST ROXBURY, MA 02132-1924
(617) 327-1350
(617) 327-1573
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
22160
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110079450A
MASS HEALTH PROVIDER
MA
Enumeration date
08/31/2011
Last updated
08/31/2011
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