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General NPI Number Information
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NPI Number | 1538824875
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Entity Type | Organization
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Legal Business Name | SUDBURY DENTAL ARTS PC
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Dates
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Enumeration Date | 11/02/2021
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 144 NORTH RD STE 2125
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City | SUDBURY
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State | MA
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Zip | 01776-1171
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Country | US
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Telephone | 617-596-6323
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Fax |
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Provider Business Mailing Address
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Address Line | 5 KERRIGAN WAY
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City | WOBURN
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State | MA
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Zip | 01801-4043
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Country | US
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Telephone | 617-596-6323
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | ALAA AHMED
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Credential |
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Telephone | 617-596-6323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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