=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376714683
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTOINE G HRAIZ DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2008
-----------------------------------------------------
Last Update Date | 03/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 184 CAMBRIDGE ST
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01803-2932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-221-0072
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 168 WHITE ST
-----------------------------------------------------
City | BELMONT
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02478-4722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 22053
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------