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General NPI Number Information
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NPI Number | 1104233634
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Entity Type | Organization
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Legal Business Name | TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 07/16/2014
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Provider Practice Location Address
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Address Line | ONE KNEELAND ST ROOM 224 TUFTS DENTAL SCHOOL
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City | BOSTON
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State | MA
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Zip | 02111
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Country | US
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Telephone | 407-421-4607
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Fax |
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Provider Business Mailing Address
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Address Line | 1 KNEELAND ST # 224
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City | BOSTON
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State | MA
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Zip | 02111-1527
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Country | US
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Telephone | 407-421-4607
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Fax |
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Authorized Official
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Title or Position | INSTRUCTOR
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Name | ALA OMAR ALI
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Credential | B.D.S., M.SC
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Telephone | 407-421-4607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DF10975
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License Number State | MA
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