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General NPI Number Information
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NPI Number | 1871761353
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Entity Type | Organization
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Legal Business Name | MAHA G BOUTROS, DMD, PC
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Dates
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Enumeration Date | 02/18/2008
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Last Update Date | 02/18/2008
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Provider Practice Location Address
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Address Line | 1 MEETING HOUSE RD SUITE # 4
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City | CHELMSFORD
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State | MA
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Zip | 01824-2733
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Country | US
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Telephone | 978-256-4551
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Fax |
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Provider Business Mailing Address
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Address Line | 1 MEETING HOUSE RD SUITE # 4
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City | CHELMSFORD
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State | MA
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Zip | 01824-2733
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Country | US
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Telephone | 978-256-4551
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAHA G BOUTROS
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Credential |
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Telephone | 978-256-4551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 18863
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License Number State | MA
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