1073994604 NPI number — MISS ABIAR ALI ALWAEL BCWD BACHELOR OF DEN

Table of content: MISS ABIAR ALI ALWAEL BCWD BACHELOR OF DEN (NPI 1073994604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073994604 NPI number — MISS ABIAR ALI ALWAEL BCWD BACHELOR OF DEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALWAEL
Provider First Name:
ABIAR
Provider Middle Name:
ALI
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
BCWD BACHELOR OF DEN
Provider Gender Code:
F

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:
1073994604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE KNEELAND STREET
Provider Second Line Business Mailing Address:
TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE, 12TH FLOOR
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE KNEELAND STREET
Provider Second Line Business Practice Location Address:
TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE 12TH FLOOR
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-636-6531
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2015

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , with the licence number: DL12693 , 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)





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