Provider Demographics
NPI:1093158420
Name:ALPHA DENTAL SOMERVILLE
Entity Type:Organization
Organization Name:ALPHA DENTAL SOMERVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:PASHA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-625-8500
Mailing Address - Street 1:701 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2223
Mailing Address - Country:US
Mailing Address - Phone:617-625-8500
Mailing Address - Fax:
Practice Address - Street 1:701 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2223
Practice Address - Country:US
Practice Address - Phone:617-625-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN210141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty