Provider Demographics
NPI:1043798168
Name:AK PELHAM DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:AK PELHAM DENTAL GROUP PLLC
Other - Org Name:MICHAEL YANNETTI
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMADA IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:857-540-0135
Mailing Address - Street 1:150 BRIDGE ST STE B
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076-3426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 BRIDGE ST STE B
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NH
Practice Address - Zip Code:03076-3426
Practice Address - Country:US
Practice Address - Phone:857-540-0135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04431122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty