MEDICARE: ZAIN ALQAWS KAMAL ISSA DDS

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	122300000X	Dentist	1856455	MA

General Provider Information

NPI Number	:	1568886315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZAIN ALQAWS KAMAL ISSA DDS

Provider Business Mailing Address
First Line	:	445 WILLARD ST UNIT 205
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-6467
Country	:	US
Telephone Number	:	803-389-8926
Fax Number	:

Provider Business Practice Location Address
First Line	:	166 COLUMBIA RD
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02121-3411
Country	:	US
Telephone Number	:	617-445-9880
Fax Number	:	617-445-5746

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

Provider Enumeration Date	:	02/14/2014
Last Update Date	:	04/24/2015

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