Provider Demographics
NPI:1114326402
Name:NEW ENGLAND DENTAL SPECIALISTS OF NORWOOD
Entity Type:Organization
Organization Name:NEW ENGLAND DENTAL SPECIALISTS OF NORWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-893-9329
Mailing Address - Street 1:24 GUILD ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3425
Mailing Address - Country:US
Mailing Address - Phone:781-551-2770
Mailing Address - Fax:
Practice Address - Street 1:24 GUILD ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3425
Practice Address - Country:US
Practice Address - Phone:781-551-2770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223P0221X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty