Healthcare Provider Details

I. General information

NPI: 1508303660
Provider Name (Legal Business Name): ASMA ALMAZYAD BDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST BRIGHAM AND WOMEN'S HOSPITAL
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST BRIGHAM AND WOMEN'S HOSPITAL
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-6974
  • Fax: 617-264-6312
Mailing address:
  • Phone: 617-732-6974
  • Fax: 617-264-6312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDL13157
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: