Provider Demographics
NPI:1093910408
Name:ALYASSI, MONAF (DMD)
Entity Type:Individual
Prefix:DR
First Name:MONAF
Middle Name:
Last Name:ALYASSI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 VILLAGE WAY
Mailing Address - Street 2:APT.# 22
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3909
Mailing Address - Country:US
Mailing Address - Phone:508-498-0967
Mailing Address - Fax:
Practice Address - Street 1:28 COREY ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1923
Practice Address - Country:US
Practice Address - Phone:508-498-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20634122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist