Healthcare Provider Details

I. General information

NPI: 1376018705
Provider Name (Legal Business Name): SIMPLY DENTAL OF BRAINTREE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FORBES RD
BRAINTREE MA
02184-2605
US

IV. Provider business mailing address

87 ELM ST STE 302
HOPKINTON MA
01748-1638
US

V. Phone/Fax

Practice location:
  • Phone: 508-589-8270
  • Fax:
Mailing address:
  • Phone: 508-589-8270
  • 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: HOUSSAM ALKHOURY
Title or Position: OWNER
Credential:
Phone: 508-589-8270