Provider Demographics
NPI:1306210562
Name:PRICHARD FAMILY DENTAL, L.L.C.
Entity Type:Organization
Organization Name:PRICHARD FAMILY DENTAL, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:EL SAMRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-582-0800
Mailing Address - Street 1:110 PRICHARD ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-7577
Mailing Address - Country:US
Mailing Address - Phone:978-343-3031
Mailing Address - Fax:978-343-3030
Practice Address - Street 1:110 PRICHARD ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-7577
Practice Address - Country:US
Practice Address - Phone:978-343-3031
Practice Address - Fax:978-343-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN201461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty