Organization
CROWNING MOMENT LLC
Active
Other names
Blue Hills Dental Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK SSU-CHIEH LEE D.M.D. (OWNER)
(617) 953-1824
Entity
Organization
Contact information
Practice address
340 WOOD RD, SUITE 288, BRAINTREE, MA 02184-2401
(617) 953-1824
Mailing address
340 WOOD RD, SUITE 288, BRAINTREE, MA 02184-2401
(617) 953-1824
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
DN1855439
MA
Other
Enumeration date
11/16/2013
Last updated
11/16/2013
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