Provider Demographics
NPI:1083698856
Name:MIDDLEBORO FAMILY DENTAL INC
Entity Type:Organization
Organization Name:MIDDLEBORO FAMILY DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YASER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WEHBE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-947-4411
Mailing Address - Street 1:1 ROCK ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-2321
Mailing Address - Country:US
Mailing Address - Phone:508-947-4411
Mailing Address - Fax:508-947-4424
Practice Address - Street 1:1 ROCK ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-2321
Practice Address - Country:US
Practice Address - Phone:508-947-4411
Practice Address - Fax:508-947-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20518122300000X
MA21226122300000X
MA140251223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty