MEDICARE: DR. MAHA G BOUTROS D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	18863	MA

General Provider Information

NPI Number	:	1174526172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAHA G BOUTROS D.M.D.

Provider Business Mailing Address
First Line	:	50 ROLLINGWOOD LN
Second Line	:
City	:	CONCORD
State	:	MA
Zip	:	01742-4302
Country	:	US
Telephone Number	:	978-369-6176
Fax Number	:	978-287-5843

Provider Business Practice Location Address
First Line	:	1 MEETING HOUSE RD
Second Line	:
City	:	CHELMSFORD
State	:	MA
Zip	:	01824-2733
Country	:	US
Telephone Number	:	978-256-4551
Fax Number	:	978-256-7074

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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