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General NPI Number Information
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NPI Number | 1487563375
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Entity Type | Organization
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Legal Business Name | VAST FAMILY DENTAL LLC
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Dates
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Enumeration Date | 09/04/2026
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Last Update Date | 09/04/2026
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Provider Practice Location Address
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Address Line | 433 WATERTOWN ST
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City | NEWTON
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State | MA
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Zip | 02458-1113
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Country | US
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Telephone | 617-658-7883
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Fax |
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Provider Business Mailing Address
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Address Line | 263 HUNTINGTON AVE UNIT 146
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City | BOSTON
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State | MA
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Zip | 02115-4577
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. IHAM GAMMAS
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Credential |
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Telephone | 617-710-5072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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