Healthcare Provider Details

I. General information

NPI: 1487563375
Provider Name (Legal Business Name): VAST FAMILY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 WATERTOWN ST
NEWTON MA
02458-1113
US

IV. Provider business mailing address

263 HUNTINGTON AVE UNIT 146
BOSTON MA
02115-4577
US

V. Phone/Fax

Practice location:
  • Phone: 617-658-7883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MR. IHAM GAMMAS
Title or Position: OWNER
Credential:
Phone: 617-710-5072