=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477976710
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEGGERICK, ALWAZZAN & NOEL DMD, PROSTHODONTISTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2014
-----------------------------------------------------
Last Update Date | 01/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 56 COLPITTS ROAD
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-894-0347
-----------------------------------------------------
Fax | 781-894-0835
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 56 COLPITTS ROAD
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-894-0347
-----------------------------------------------------
Fax | 781-894-0835
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALAA HEGGERICK, ALWAZZAN
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 781-894-0347
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | DN22162
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------