Healthcare Provider Details

I. General information

NPI: 1942798392
Provider Name (Legal Business Name): SIMPLY DENTAL AT WORCESTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 GROVE ST
WORCESTER MA
01605-1225
US

IV. Provider business mailing address

87 ELM ST STE 302
HOPKINTON MA
01748-1638
US

V. Phone/Fax

Practice location:
  • Phone: 508-589-8270
  • Fax: 508-435-2690
Mailing address:
  • Phone: 508-589-8270
  • Fax: 508-435-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN20511
License Number StateMA

VIII. Authorized Official

Name: HOUSSAM ALKHOURY
Title or Position: OWNER
Credential:
Phone: 508-589-8270