MEDICARE: EYAD NASSER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	DN10000278	MA

General Provider Information

NPI Number	:	1255180295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EYAD NASSER

Provider Business Mailing Address
First Line	:	333 WARREN ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02119-1850
Country	:	US
Telephone Number	:	617-427-4242
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 WARREN ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02119-1850
Country	:	US
Telephone Number	:	617-427-4242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2024
Last Update Date	:	06/28/2024

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Directions to “ EYAD NASSER ” Practice Location

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