Healthcare Provider Details

I. General information

NPI: 1194419093
Provider Name (Legal Business Name): DENTAL HQ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 UNION ST
BRIDGEWATER MA
02324-1412
US

IV. Provider business mailing address

23 UNION ST
BRIDGEWATER MA
02324-1412
US

V. Phone/Fax

Practice location:
  • Phone: 508-697-6596
  • 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. OMAR AL-KAZAZ
Title or Position: DENTIST
Credential: DMD
Phone: 617-990-2143