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General NPI Number Information
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NPI Number | 1720508161
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Entity Type | Organization
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Legal Business Name | UNIQUE DENTAL OF WINCHENDON LLC
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 06/27/2017
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Provider Practice Location Address
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Address Line | 77 CENTRAL ST
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City | WINCHENDON
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State | MA
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Zip | 01475-1609
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Country | US
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Telephone | 978-297-0675
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Fax |
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Provider Business Mailing Address
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Address Line | 16 SCARLET CT
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City | NORTH EASTON
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State | MA
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Zip | 02356-3625
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Country | US
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Telephone | 508-297-0143
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. YASER JOHN WEHBE
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Credential | DMD
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Telephone | 781-632-3336
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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 | 20518
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License Number State | MA
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