Healthcare Provider Details

I. General information

NPI: 1205120276
Provider Name (Legal Business Name): SABAH AHMED MEKKI MAHADI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N MAIN ST
RANDOLPH MA
02368-3064
US

IV. Provider business mailing address

504 SHERMAN ST APT 19
CANTON MA
02021-2558
US

V. Phone/Fax

Practice location:
  • Phone: 781-963-2222
  • Fax:
Mailing address:
  • Phone: 971-570-4196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1855682
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: