Provider Demographics
NPI:1346607389
Name:UNIQUE DENTAL LLC
Entity Type:Organization
Organization Name:UNIQUE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ZYOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-312-9177
Mailing Address - Street 1:64 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-2110
Mailing Address - Country:US
Mailing Address - Phone:617-312-9177
Mailing Address - Fax:508-302-0272
Practice Address - Street 1:64 GROVE ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-2110
Practice Address - Country:US
Practice Address - Phone:617-312-9177
Practice Address - Fax:508-302-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty