=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861672750
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WAKEFIELD FAMILY DENTAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2007
-----------------------------------------------------
Last Update Date | 11/07/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 ALBION ST.
-----------------------------------------------------
City | WAKEFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-245-2566
-----------------------------------------------------
Fax | 781-246-1999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 ALBION ST.
-----------------------------------------------------
City | WAKEFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-245-2566
-----------------------------------------------------
Fax | 781-246-1999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DR.
-----------------------------------------------------
Name | DR. MONA EL-SHEIKH
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 781-245-2566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 20377
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------