Provider Demographics
NPI:1073852901
Name:SAM KHAYAT DMD PC
Entity Type:Organization
Organization Name:SAM KHAYAT DMD PC
Other - Org Name:SOUTH SHORE PROSTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAYAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-416-0411
Mailing Address - Street 1:210 WHITING ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-3724
Mailing Address - Country:US
Mailing Address - Phone:781-749-6050
Mailing Address - Fax:781-749-2201
Practice Address - Street 1:210 WHITING ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3724
Practice Address - Country:US
Practice Address - Phone:781-749-6050
Practice Address - Fax:781-749-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18558201223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty