Healthcare Provider Details

I. General information

NPI: 1578436093
Provider Name (Legal Business Name): SPECIALIZED GROUP PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BOYLSTON ST FL 2
BOSTON MA
02199-8081
US

IV. Provider business mailing address

460 HARRISON AVE UNIT 227C
BOSTON MA
02118-2874
US

V. Phone/Fax

Practice location:
  • Phone: 617-206-1712
  • Fax:
Mailing address:
  • Phone: 617-595-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERT ZEBOUNI
Title or Position: SOLE MEMBER
Credential: DMD
Phone: 617-595-3600