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General NPI Number Information
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NPI Number | 1184365942
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Entity Type | Organization
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Legal Business Name | DANVERS AESTHETIC FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 2 ORCHARD LN STE C
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City | DANVERS
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State | MA
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Zip | 01923-3428
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Country | US
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Telephone | 978-774-0725
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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 | 617-669-9839
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. 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 | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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