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General NPI Number Information
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NPI Number | 1144701020
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Entity Type | Organization
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Legal Business Name | 41 STATE RD, LLC
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 1379 TUCKER ROAD
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City | NORTH DARTMOUTH
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State | MA
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Zip | 02747
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Country | US
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Telephone | 508-993-9105
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Fax | 508-993-9115
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Provider Business Mailing Address
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Address Line | 1379 TUCKER ROAD
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City | NORTH DARTMOUTH
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State | MA
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Zip | 02747
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Country | US
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Telephone | 508-993-9105
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Fax | 508-993-9115
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Authorized Official
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Title or Position | PERIODONTIST/OWNER
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Name | MAHMOUD HAMAD
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Credential | DMD
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Telephone | 508-993-9105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN1856413
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License Number State | MA
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