Healthcare Provider Details

I. General information

NPI: 1225773153
Provider Name (Legal Business Name): AHMAD MAJZOUB DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HAZARD AVE
ENFIELD CT
06082-3725
US

IV. Provider business mailing address

25 HAZARD AVE
ENFIELD CT
06082-3725
US

V. Phone/Fax

Practice location:
  • Phone: 860-745-0777
  • Fax: 860-745-7292
Mailing address:
  • Phone: 860-745-0777
  • Fax: 860-745-7292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN31109
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN10001434
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number14747
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: