Healthcare Provider Details

I. General information

NPI: 1740445923
Provider Name (Legal Business Name): ATHBI H ALQAREER B.D.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2008
Last Update Date: 07/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 LONGWOOD AVE
BOSTON MA
02115-5819
US

IV. Provider business mailing address

PO BOX 66557 BAYAN HOUSE 28, 1ST STREET, BLOCK 10
BAYAN KUWAIT
43756
KW

V. Phone/Fax

Practice location:
  • Phone: 617-432-4281
  • Fax:
Mailing address:
  • Phone: 965-974-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9617
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: