Provider Demographics
NPI:1114708724
Name:ABUHAIMED, ABDULLATIF
Entity Type:Individual
Prefix:DR
First Name:ABDULLATIF
Middle Name:
Last Name:ABUHAIMED
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ABDULLATIF
Other - Middle Name:M
Other - Last Name:ABUHAIMED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BDS
Mailing Address - Street 1:61 LOCUST ST APT 237
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5799
Mailing Address - Country:US
Mailing Address - Phone:781-957-7796
Mailing Address - Fax:
Practice Address - Street 1:1 KNEELAND ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1527
Practice Address - Country:US
Practice Address - Phone:781-957-7796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL15930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist