Organization
ACE DENTAL WEST ROXBURY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAWN KIM DDS (MANAGER)
(617) 361-5020
Entity
Organization
Contact information
Practice address
1840 CENTRE ST, WEST ROXBURY, MA 02132-1901
(617) 327-5700
Mailing address
1138 RIVER ST, HYDE PARK, MA 02136-2970
(617) 361-5020
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN1856147
DENTAL LICENSE NUMBER
MA
Enumeration date
01/26/2022
Last updated
01/26/2022
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