MEDICARE: MAHA G BOUTROS, DMD, PC

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	122300000X	Dentist	18863	MA

General Provider Information

NPI Number	:	1871761353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHA G BOUTROS, DMD, PC

Provider Business Mailing Address
First Line	:	1 MEETING HOUSE RD
Second Line	:	SUITE # 4
City	:	CHELMSFORD
State	:	MA
Zip	:	01824-2733
Country	:	US
Telephone Number	:	978-256-4551
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MEETING HOUSE RD
Second Line	:	SUITE # 4
City	:	CHELMSFORD
State	:	MA
Zip	:	01824-2733
Country	:	US
Telephone Number	:	978-256-4551
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MAHA G BOUTROS
Credential	:
Telephone Number	:	978-256-4551

Provider Enumeration Date	:	02/18/2008
Last Update Date	:	02/18/2008

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