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General NPI Number Information
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NPI Number | 1619497955
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Entity Type | Organization
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Legal Business Name | FRAMIGHAM ORTHODONTICS PC
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 07/19/2024
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Provider Practice Location Address
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Address Line | 55 MAIN ST STE 1
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City | FRAMINGHAM
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State | MA
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Zip | 01702-2934
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Country | US
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Telephone | 508-872-8575
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Fax | 508-872-1427
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Provider Business Mailing Address
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Address Line | 55 MAIN ST STE 1
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City | FRAMINGHAM
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State | MA
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Zip | 01702-2934
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Country | US
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Telephone | 508-872-8575
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Fax | 508-872-1427
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. KAMAR BALOUL
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Credential | DMD
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Telephone | 508-578-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN20603
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License Number State | MA
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