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General NPI Number Information
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NPI Number | 1154818359
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Entity Type | Organization
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Legal Business Name | LEXINGTON SMILE STUDIO, PC
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 922 WALTHAM ST STE 202
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City | LEXINGTON
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State | MA
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Zip | 02421-8019
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Country | US
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Telephone | 781-861-7645
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Fax |
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Provider Business Mailing Address
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Address Line | 500 ATLANTIC AVE UNIT 14K
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City | BOSTON
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State | MA
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Zip | 02210-2245
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Country | US
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Telephone | 176-699-8396
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALAAEDDIN ALWAZZAN
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Credential | DMD
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Telephone | 617-669-9839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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