1326349150 NPI number — NEW CONCEPTS DENTAL GROUP

Table of content: (NPI 1326349150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326349150 NPI number — NEW CONCEPTS DENTAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW CONCEPTS DENTAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1326349150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 BOSTON ROAD
Provider Second Line Business Mailing Address:
UNIT #16
Provider Business Mailing Address City Name:
NO. BILLERICA
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-663-7638
Provider Business Mailing Address Fax Number:
978-667-9856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 BOSTON ROAD
Provider Second Line Business Practice Location Address:
UNIT #16
Provider Business Practice Location Address City Name:
NO. BILLERICA
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-663-7638
Provider Business Practice Location Address Fax Number:
978-667-9856
Provider Enumeration Date:
11/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JARADEH
Authorized Official First Name:
MAJED
Authorized Official Middle Name:
E
Authorized Official Title or Position:
DENTIST/OWNER
Authorized Official Telephone Number:
978-663-7638

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com