Healthcare Provider Details

I. General information

NPI: 1306692405
Provider Name (Legal Business Name): ALAA SUBAHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E MOUNTAIN ST APT 238
WORCESTER MA
01606-1221
US

IV. Provider business mailing address

190 E MOUNTAIN ST APT 238
WORCESTER MA
01606-1221
US

V. Phone/Fax

Practice location:
  • Phone: 248-525-5292
  • Fax:
Mailing address:
  • Phone: 248-525-5292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN10001645
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: