Provider Demographics
NPI:1427484062
Name:SOUTH SHORE PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:SOUTH SHORE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:SANGGUOT
Authorized Official - Last Name:HUA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-340-5437
Mailing Address - Street 1:5 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-2108
Mailing Address - Country:US
Mailing Address - Phone:781-340-5437
Mailing Address - Fax:781-340-5438
Practice Address - Street 1:5 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-2108
Practice Address - Country:US
Practice Address - Phone:781-340-5437
Practice Address - Fax:781-340-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-15
Last Update Date:2013-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18552051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty