Healthcare Provider Details

I. General information

NPI: 1669140182
Provider Name (Legal Business Name): SIMPLY ORTHODONTICS OF LUDLOW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 CHAPIN ST STE 300
LUDLOW MA
01056-1900
US

IV. Provider business mailing address

87 ELM ST
HOPKINTON MA
01748-1638
US

V. Phone/Fax

Practice location:
  • Phone: 413-547-0300
  • Fax:
Mailing address:
  • Phone: 508-589-8270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. HOUSSAM ALKHOURY
Title or Position: OWNER
Credential: DMD
Phone: 508-589-8270