Healthcare Provider Details

I. General information

NPI: 1861093189
Provider Name (Legal Business Name): RANA DABBAGH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 W MAIN ST
WEST BROOKFIELD MA
01585-2823
US

IV. Provider business mailing address

4 EMERSON CIR
SHREWSBURY MA
01545-3965
US

V. Phone/Fax

Practice location:
  • Phone: 508-637-5140
  • Fax:
Mailing address:
  • Phone: 508-688-7869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1858809
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: