Provider Demographics
NPI:1699876318
Name:BCH DENTAL GROUP
Entity type:Organization
Organization Name:BCH DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:MAN WAI
Authorized Official - Middle Name:
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-355-6000
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6000
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:PATIENT FINANCIAL SERVICES ATN STEVEN NICOLL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-4831
Practice Address - Fax:617-730-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008455Medicaid
NH30310052Medicaid
RICH29439Medicaid
NY00055868Medicaid
MAX10875OtherBLUE CROSS DENTAL
MA1200445Medicaid
ME149560100Medicaid
MAX10875OtherBLUE CROSS DENTAL
RICH29439Medicaid