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General NPI Number Information
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NPI Number | 1306655691
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Entity Type | Individual
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Provider Name | YAZAN KHAIR EDDIN ALMANSOUR BDS
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Gender | Male
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 326 NICHOLS RD
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City | FITCHBURG
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State | MA
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Zip | 01420-1914
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Country | US
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Telephone | 978-878-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 169 MAIN ST
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City | COHOES
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State | NY
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Zip | 12047-4509
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Country | US
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Telephone | 616-261-1377
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DL100582
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License Number State | MA
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