MEDICARE: DENTAL HQB PLLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1710838081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL HQB PLLC

Provider Business Mailing Address
First Line	:	259 CENTRE ST
Second Line	:
City	:	MIDDLEBORO
State	:	MA
Zip	:	02346-2234
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	259 CENTRE ST
Second Line	:
City	:	MIDDLEBORO
State	:	MA
Zip	:	02346-2234
Country	:	US
Telephone Number	:	508-947-7758
Fax Number	:

Authorized Official
Title or Position	:	PARTNER DENTIST
Name	:	DR. OMAR AL-KAZAZ
Credential	:	DMD
Telephone Number	:	617-990-2143

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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