Organization
PONDSIDE ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN TIEU D.D.S (OWNER/ DENTIST)
(617) 522-1970
Entity
Organization
Contact information
Practice address
793 CENTRE ST, JAMAICA PLAIN, MA 02130-2736
(617) 522-1970
Mailing address
P.O.BOX 301697, JAMAICA PLAIN, MA 02130
(617) 522-1970
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
20059
MA
Other
Enumeration date
11/23/2007
Last updated
11/23/2007
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