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General NPI Number Information
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NPI Number | 1295135085
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Entity Type | Organization
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Legal Business Name | WAVERLY OAKS DENTAL, INC.
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Dates
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Enumeration Date | 08/28/2014
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Last Update Date | 08/28/2014
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Provider Practice Location Address
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Address Line | 411 WAVERLY OAKS RD SUITE 318
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City | WALTHAM
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State | MA
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Zip | 02452-8448
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Country | US
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Telephone | 781-649-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 411 WAVERLY OAKS RD SUITE 318
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City | WALTHAM
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State | MA
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Zip | 02452-8448
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Country | US
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Telephone | 781-649-0022
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEILA ZAMANI
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Credential | DMD
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Telephone | 781-649-0022
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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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