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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