Healthcare Provider Details

I. General information

NPI: 1174946990
Provider Name (Legal Business Name): MAHER ALNAMMARY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST BRIGHAM AND WOMEN'S HOSPITAL - DIV. ORAL MEDICINE
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST BRIGHAM AND WOMEN'S HOSPITAL - DIV. ORAL MEDICINE
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-6684
  • Fax: 617-232-8970
Mailing address:
  • Phone: 617-732-6684
  • Fax: 617-232-8970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDL12121
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: