Provider Demographics
NPI:1114105798
Name:SUMBUL Z. NAQVI D.M.D., INC
Entity Type:Organization
Organization Name:SUMBUL Z. NAQVI D.M.D., INC
Other - Org Name:ATLANTIS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMBUL
Authorized Official - Middle Name:Z
Authorized Official - Last Name:NAQVI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-519-8928
Mailing Address - Street 1:118 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8304
Mailing Address - Country:US
Mailing Address - Phone:508-270-5050
Mailing Address - Fax:508-270-5060
Practice Address - Street 1:118 CONCORD ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8304
Practice Address - Country:US
Practice Address - Phone:508-270-5050
Practice Address - Fax:508-270-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0206482Medicaid
MA1881729168OtherNPI TYPE I