Organization · NPI-2

Bay State Dental Specialists PC

Dentist, Periodontics · Winchester, MA

NPI number1124135439
StatusActive
Last updated in NPPESAug 29, 2007

Details

NPI
1124135439
Entity type
Organization (NPI-2)
Legal business name
Bay State Dental Specialists PC
Organization subpart
No
Enumeration date
Aug 23, 2006
Last updated
Aug 29, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223P0300X Dentist, Periodontics18623MAYes

Practice location

10 Converse Place
4th Floor
Winchester, MA 01890

Phone 781-727-4644 · Fax 781-729-0581

Mailing address

10 Converse Place
4th Floor
Winchester, MA 01890

Phone 781-727-4644 · Fax 781-729-0581

Authorized official

Noha Anan Elkadry
President
7817294644

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