Healthcare Provider Details

I. General information

NPI: 1710733811
Provider Name (Legal Business Name): MONIA OSAMMA AHMED ABUELBASHER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 COLLEGE HWY
SOUTHWICK MA
01077-9828
US

IV. Provider business mailing address

627 COLLEGE HWY
SOUTHWICK MA
01077-9828
US

V. Phone/Fax

Practice location:
  • Phone: 413-569-3170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10001390
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: