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General NPI Number Information
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NPI Number | 1255052833
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Entity Type | Individual
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Provider Name | LARA HADDAD DMD
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Gender | Female
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 11 W MAIN ST
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City | WESTBOROUGH
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State | MA
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Zip | 01581-1936
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Country | US
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Telephone | 617-417-6897
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Fax |
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Provider Business Mailing Address
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Address Line | 404 LANGLEY RD APT 206
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City | NEWTON
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State | MA
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Zip | 02459-2318
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1859595
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License Number State | MA
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