Provider Demographics
NPI:1043228976
Name:FAMILY DENTAL GROUP
Entity Type:Organization
Organization Name:FAMILY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:AHED
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-366-7450
Mailing Address - Street 1:276 TURNPIKE RD
Mailing Address - Street 2:SUITE 226
Mailing Address - City:WESTBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01581
Mailing Address - Country:US
Mailing Address - Phone:508-366-7450
Mailing Address - Fax:508-366-7475
Practice Address - Street 1:276 TURNPIKE RD
Practice Address - Street 2:SUITE 226
Practice Address - City:WESTBORO
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-366-7450
Practice Address - Fax:508-366-7475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA188271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty