Healthcare Provider Details

I. General information

NPI: 1780273052
Provider Name (Legal Business Name): WORCESTER ENDODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 PARK AVE STE 303
WORCESTER MA
01609-1985
US

IV. Provider business mailing address

87 ELM ST
HOPKINTON MA
01748-1638
US

V. Phone/Fax

Practice location:
  • Phone: 508-755-3636
  • Fax:
Mailing address:
  • Phone: 508-589-8270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

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