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General NPI Number Information
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NPI Number | 1942751953
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Entity Type | Organization
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Legal Business Name | MELROSE FAMILY DENTAL PC
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 12 PORTER ST
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City | MELROSE
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State | MA
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Zip | 02176-2810
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Country | US
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Telephone | 781-665-1552
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Fax |
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Provider Business Mailing Address
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Address Line | 12 PORTER ST
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City | MELROSE
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State | MA
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Zip | 02176-2810
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Country | US
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Telephone | 781-665-1552
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALAAEDDIN ALWAZZAN
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Credential | DMD, FACP
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Telephone | 617-669-9839
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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 | DN1855140
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN13354
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN22162
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License Number State | MA
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