Healthcare Provider Details

I. General information

NPI: 1033510763
Provider Name (Legal Business Name): QURRAT-UL-ANNE YOUSAF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 PLEASANT LAKE AVE
HARWICH MA
02645-1813
US

IV. Provider business mailing address

1135 MORTON ST
MATTAPAN MA
02126-2834
US

V. Phone/Fax

Practice location:
  • Phone: 508-778-5400
  • Fax:
Mailing address:
  • Phone: 617-533-2346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL12392
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: