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General NPI Number Information
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NPI Number | 1891288684
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Entity Type | Organization
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Legal Business Name | SIMPLY ORTHODONTICS MA PLLC
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 4 FRANKLIN ST STE 14
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City | MILTON
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State | MA
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Zip | 02186-5522
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Country | US
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Telephone | 508-589-8270
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Fax | 508-435-2690
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Provider Business Mailing Address
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Address Line | 87 ELM ST STE 302
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City | HOPKINTON
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State | MA
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Zip | 01748-1638
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Country | US
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Telephone | 508-589-8270
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Fax | 508-435-2690
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Authorized Official
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Title or Position | OWNER
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Name | HOUSSAM ALKHOURY
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Credential | DMD
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Telephone | 508-589-8270
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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 | DN20511
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License Number State | MA
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