Healthcare Provider Details

I. General information

NPI: 1912371808
Provider Name (Legal Business Name): MAHER HAJJAJ BDS, MSD, FRCDC, DSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E NEWTON ST ROOM G716
BOSTON MA
02118-2308
US

IV. Provider business mailing address

8 9TH ST APT 304
MEDFORD MA
02155-5144
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-4636
  • Fax: 617-638-5322
Mailing address:
  • Phone: 317-531-3512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberBB1832268AMJJ1
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: