Healthcare Provider Details

I. General information

NPI: 1902717333
Provider Name (Legal Business Name): MAHER KHUZAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 ALBANY ST
BOSTON MA
02118-3550
US

IV. Provider business mailing address

13 SHETLAND ST APT 315
ROXBURY MA
02119-4211
US

V. Phone/Fax

Practice location:
  • Phone: 617-358-6560
  • Fax:
Mailing address:
  • Phone: 847-525-0896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL101825
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: