Provider Demographics
NPI:1588865349
Name:JOHN T. TIEU D.M.D, P.C.
Entity type:Organization
Organization Name:JOHN T. TIEU D.M.D, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:TIEU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-442-2535
Mailing Address - Street 1:101 ALLSTATE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-1641
Mailing Address - Country:US
Mailing Address - Phone:617-442-2535
Mailing Address - Fax:
Practice Address - Street 1:101 ALLSTATE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-1641
Practice Address - Country:US
Practice Address - Phone:617-442-2535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty