Healthcare Provider Details

I. General information

NPI: 1740184498
Provider Name (Legal Business Name): IMPACT ORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 ACCESS RD UNIT 1
NORWOOD MA
02062-5211
US

IV. Provider business mailing address

1 EVERETT TER
NATICK MA
01760-5568
US

V. Phone/Fax

Practice location:
  • Phone: 404-860-3592
  • Fax:
Mailing address:
  • Phone: 404-860-3592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateNULL

VIII. Authorized Official

Name: HAMZA AL ATASSI
Title or Position: OWNER
Credential: DMD
Phone: 404-860-3592