Healthcare Provider Details

I. General information

NPI: 1336064369
Provider Name (Legal Business Name): NAS DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379A CENTRE ST
BOSTON MA
02130-1241
US

IV. Provider business mailing address

169 COREY ST
WEST ROXBURY MA
02132-2339
US

V. Phone/Fax

Practice location:
  • Phone: 585-831-2456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NUBA AFZAL SIDDIQI
Title or Position: GENERAL DENTIST
Credential: DMD
Phone: 585-831-2456