=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861256869
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASEEL FAMILY AND COSMETIC DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2024
-----------------------------------------------------
Last Update Date | 02/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4354 WASHINGTON ST UNIT A
-----------------------------------------------------
City | ROSLINDALE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02131-3481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-203-9391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4354 WASHINGTON ST UNIT A
-----------------------------------------------------
City | ROSLINDALE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02131-3481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-203-9391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. ASMA BEN SALAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 857-203-9391
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------