Organization
SOUTH BOSTON FAMILY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONNIE LIU (OFFICE MANAGER)
(617) 584-0141
Entity
Organization
Contact information
Practice address
591 E BROADWAY, SOUTH BOSTON, MA 02127-4404
(617) 268-5638
Mailing address
591 E BROADWAY, SOUTH BOSTON, MA 02127-4404
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
18625
MA
Other
Enumeration date
08/02/2014
Last updated
08/02/2014
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