Provider Demographics
NPI:1386498897
Name:UNION DENTAL MILFORD
Entity type:Organization
Organization Name:UNION DENTAL MILFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:HAOYU
Authorized Official - Last Name:TONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-888-4672
Mailing Address - Street 1:29 GLENHAM ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-3128
Mailing Address - Country:US
Mailing Address - Phone:617-888-5402
Mailing Address - Fax:
Practice Address - Street 1:12 ASYLUM ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2203
Practice Address - Country:US
Practice Address - Phone:508-738-3588
Practice Address - Fax:508-306-9691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty