Organization
BOSTON FAMILY DENTAL LLC
Active
Other names
Ted Lee DMD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TED LEE DMD (PRACTICE MANAGER)
(781) 397-8876
Entity
Organization
Contact information
Practice address
572 PLEASANT ST., MALDEN, MA 02148
(781) 397-8876
(781) 324-7166
Mailing address
572 PLEASANT ST., MALDEN, MA 02148
(781) 397-8876
(781) 324-7166
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
16528
MA
1223P0300X
Periodontics
18893
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
611
DELTA
MA
05
—
8587166
—
MA
01
—
X11902LE
BCBS
MA
Enumeration date
11/27/2006
Last updated
01/21/2020
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