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General NPI Number Information
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NPI Number | 1295296671
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Entity Type | Individual
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Provider Name | KHALED MOHAMED ASAAD BDS
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Gender | Male
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Dates
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Enumeration Date | 03/27/2019
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 45 DIMOCK ST
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City | ROXBURY
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State | MA
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Zip | 02119-1208
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Country | US
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Telephone | 617-442-8800
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Fax | 617-541-0950
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Provider Business Mailing Address
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Address Line | 55 DIMOCK ST
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City | ROXBURY
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State | MA
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Zip | 02119-1029
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Country | US
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Telephone | 312-504-8480
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DL14498
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DL15167
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License Number State | MA
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