Healthcare Provider Details

I. General information

NPI: 1043709280
Provider Name (Legal Business Name): JOHN KOUNSALIEH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 WASHINGTON ST STE A-140
ATTLEBORO MA
02703-5561
US

IV. Provider business mailing address

450B PARADISE RD # 318
SWAMPSCOTT MA
01907-1300
US

V. Phone/Fax

Practice location:
  • Phone: 774-206-5592
  • Fax:
Mailing address:
  • Phone: 617-759-0178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN1859172
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: