Healthcare Provider Details

I. General information

NPI: 1275856494
Provider Name (Legal Business Name): WATERTOWN DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51A GALEN STREET
WATERTOWN MA
02472
US

IV. Provider business mailing address

51A GALEN STREET
WATERTOWN MA
02472
US

V. Phone/Fax

Practice location:
  • Phone: 617-600-3442
  • Fax: 617-600-3448
Mailing address:
  • Phone: 617-600-3442
  • Fax: 617-600-3448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19968
License Number StateMA

VIII. Authorized Official

Name: DR. YOUSRY ATTIA
Title or Position: OWNER
Credential: DMD
Phone: 617-600-3442