Healthcare Provider Details

I. General information

NPI: 1841350329
Provider Name (Legal Business Name): BEDFORD DENTAL ARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 NORTH RD SUITE 207
BEDFORD MA
01730-1037
US

IV. Provider business mailing address

41 NORTH RD SUITE 207
BEDFORD MA
01730-1037
US

V. Phone/Fax

Practice location:
  • Phone: 781-275-6365
  • Fax: 781-275-2273
Mailing address:
  • Phone: 781-275-6365
  • Fax: 781-275-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. WASSEEM AL ATTAR
Title or Position: OWNER
Credential: DMD
Phone: 781-275-6365