MEDICARE: SUDBURY DENTAL ARTS PC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1538824875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUDBURY DENTAL ARTS PC

Provider Business Mailing Address
First Line	:	5 KERRIGAN WAY
Second Line	:
City	:	WOBURN
State	:	MA
Zip	:	01801-4043
Country	:	US
Telephone Number	:	617-596-6323
Fax Number	:

Provider Business Practice Location Address
First Line	:	144 NORTH RD STE 2125
Second Line	:
City	:	SUDBURY
State	:	MA
Zip	:	01776-1171
Country	:	US
Telephone Number	:	617-596-6323
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	ALAA AHMED
Credential	:
Telephone Number	:	617-596-6323

Provider Enumeration Date	:	11/02/2021
Last Update Date	:	11/02/2021

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Directions to “SUDBURY DENTAL ARTS PC ” Practice Location

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