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General NPI Number Information
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NPI Number | 1710218425
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Entity Type | Organization
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Legal Business Name | ALAA ALWAZZAN DMD PC
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Dates
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Enumeration Date | 01/20/2010
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 580 HANCOCK ST
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City | QUINCY
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State | MA
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Zip | 02170-1909
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Country | US
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Telephone | 617-328-5060
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Fax |
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Provider Business Mailing Address
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Address Line | 580 HANCOCK ST
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City | QUINCY
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State | MA
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Zip | 02170-1909
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Country | US
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Telephone | 617-328-5060
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Fax |
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Authorized Official
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Title or Position | DENTIST, PRESIDENT
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Name | DR. ALAAEDDIN ALWAZZAN
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Credential | DMD, MSC, FACP
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Telephone | 617-328-5060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 22162
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License Number State | MA
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