Healthcare Provider Details

I. General information

NPI: 1619072402
Provider Name (Legal Business Name): MAHMOUD HADIDY DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 E MAIN ST
WESTBOROUGH MA
01581
US

IV. Provider business mailing address

176 E MAIN ST
WESTBOROUGH MA
01581
US

V. Phone/Fax

Practice location:
  • Phone: 508-366-8300
  • Fax: 508-870-1848
Mailing address:
  • Phone: 508-366-8300
  • Fax: 508-870-1848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15469
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number19353
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19841
License Number StateMA

VIII. Authorized Official

Name: DR. KHALED CHARLES ZOHNI
Title or Position: DENTIST
Credential: DMD
Phone: 508-366-8300