| Organization Name: | MARION VILLAGE DENTAL |
| NPI Number: | 1093128225 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHUONG PHAM (PRESIDENT/DENTIST PROVIDER) |
| Mailing Address: | 54 Main Street Suite 6 C/o Lakeville Dental Lakeville |
| State: | MA US |
| Postal Code: | 02347 |
| Phone Number: | 5089236900 |
| Fax Number: | |
| NPI Enumeration Date: | 06/05/2014 |
| NPI Last Update Date: | 06/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 20826 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |