Healthcare Provider Details

I. General information

NPI: 1992871115
Provider Name (Legal Business Name): ORCHARD FAMILY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 MAIN ST SUITE A
INDIAN ORCHARD MA
01151-1238
US

IV. Provider business mailing address

439 MAIN STREET SUITE A
INDIAN ORCHARD MA
01151
US

V. Phone/Fax

Practice location:
  • Phone: 413-543-1202
  • Fax: 413-543-4751
Mailing address:
  • Phone: 413-543-1202
  • Fax: 413-543-4751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMER M TAHOUN
Title or Position: OWNER
Credential: DMD
Phone: 413-543-1202