Healthcare Provider Details

I. General information

NPI: 1215892948
Provider Name (Legal Business Name): AHMED HAMDAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 ATHOL RD
ORANGE MA
01364
US

IV. Provider business mailing address

9303 QUALIS NEST. CORDOVA
MEM TN
38018
US

V. Phone/Fax

Practice location:
  • Phone: 978-544-1576
  • Fax: 978-248-9837
Mailing address:
  • Phone: 615-497-7381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDL100911
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: