Healthcare Provider Details

I. General information

NPI: 1093678773
Provider Name (Legal Business Name): DELLAL HADJADJ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 GOVERNORS DR APT 32
WINTHROP MA
02152-3245
US

IV. Provider business mailing address

900 GOVERNORS DR APT 32
WINTHROP MA
02152-3245
US

V. Phone/Fax

Practice location:
  • Phone: 339-208-7472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: