Provider Demographics
NPI:1043394372
Name:WESTSIDE DENTAL ,INC.
Entity Type:Organization
Organization Name:WESTSIDE DENTAL ,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOSSRI
Authorized Official - Middle Name:MAHIR
Authorized Official - Last Name:KAIRLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-732-0660
Mailing Address - Street 1:11 WESTFIELD STREET
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089
Mailing Address - Country:US
Mailing Address - Phone:413-732-0660
Mailing Address - Fax:413-732-0135
Practice Address - Street 1:11 WESTFIELD STREET
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089
Practice Address - Country:US
Practice Address - Phone:413-732-0660
Practice Address - Fax:413-732-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty