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General NPI Number Information
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NPI Number | 1043646417
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Entity Type | Individual
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Provider Name | HAYTHAM S JAHA BDS
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Gender | Male
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 09/17/2013
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Provider Practice Location Address
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Address Line | 100 E NEWTON ST
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City | BOSTON
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State | MA
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Zip | 02118-2308
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Country | US
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Telephone | 617-638-4748
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Fax |
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Provider Business Mailing Address
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Address Line | 160 PLEASANT ST APT#: 807
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City | MALDEN
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State | MA
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Zip | 02148-4832
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Country | US
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Telephone | 617-971-7666
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DL12056
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License Number State | MA
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