Healthcare Provider Details

I. General information

NPI: 1912825142
Provider Name (Legal Business Name): EJAZ KHAWER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTH ADAMS DENTAL CENTER, 77 HOSPITAL AVE SUITE 102
NORTH ADAMS MA
01247-2538
US

IV. Provider business mailing address

77 HOSPITAL AVE STE 102
NORTH ADAMS MA
01247-2538
US

V. Phone/Fax

Practice location:
  • Phone: 413-346-4242
  • Fax:
Mailing address:
  • Phone: 413-346-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL101479
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: