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General NPI Number Information
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NPI Number | 1689441792
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Entity Type | Organization
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Legal Business Name | WALTHAM DENTAL GROUP
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Dates
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Enumeration Date | 12/08/2023
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Last Update Date | 12/08/2023
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Provider Practice Location Address
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Address Line | 32 SOUTH ST STE 202
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City | WALTHAM
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State | MA
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Zip | 02453-3555
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Country | US
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Telephone | 781-894-2122
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Fax |
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Provider Business Mailing Address
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Address Line | 32 SOUTH ST STE 202
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City | WALTHAM
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State | MA
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Zip | 02453-3555
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Country | US
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Telephone | 781-894-2122
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Fax |
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | AHMED MIHYAWI
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Credential |
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Telephone | 617-780-8299
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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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