1255793733 NPI number — AINA WILLIAM ANIBABA DDS, MBA

Table of content: AINA WILLIAM ANIBABA DDS, MBA (NPI 1255793733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255793733 NPI number — AINA WILLIAM ANIBABA DDS, MBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANIBABA
Provider First Name:
AINA
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS, MBA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255793733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
269 UNION ST
Provider Second Line Business Mailing Address:
2ND FLOOR DENTAL
Provider Business Mailing Address City Name:
LYNN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01901-1314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-581-9832
Provider Business Mailing Address Fax Number:
781-581-9583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
269 UNION ST
Provider Second Line Business Practice Location Address:
2ND FLOOR DENTAL
Provider Business Practice Location Address City Name:
LYNN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01901-1314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-581-9832
Provider Business Practice Location Address Fax Number:
781-581-9583
Provider Enumeration Date:
03/24/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DL12833 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)