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NPI Code Detail

MEDICARE: WEST SOMERVILLE DENTAL

MEDICARE: WEST SOMERVILLE DENTAL
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
11223P0300XPeriodonticsMA
2124Q00000XDental HygienistMA
31223G0001XGeneral Practice DentistryMA

General Provider Information

NPI Number : 1518269810
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEST SOMERVILLE DENTAL
Provider Business Mailing Address
First Line : 124 COLLEGE AVE
Second Line :
City : SOMERVILLE
State : MA
Zip : 02144-1919
Country : US
Telephone Number : 617-625-0543
Fax Number : 617-666-5034
Provider Business Practice Location Address
First Line : 124 COLLEGE AVE
Second Line :
City : SOMERVILLE
State : MA
Zip : 02144-1919
Country : US
Telephone Number : 617-625-0543
Fax Number : 617-666-5034
Authorized Official
Title or Position : OWNER
Name : DR. MARHAMA ALVI-SHAH
Credential :
Telephone Number : 617-625-0543
Provider Enumeration Date : 11/19/2010
Last Update Date : 11/19/2010

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Directions to “WEST SOMERVILLE DENTAL ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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