Provider Demographics
NPI:1346622529
Name:HAMASAT GHEDDAF DAM, DMD,PC
Entity Type:Organization
Organization Name:HAMASAT GHEDDAF DAM, DMD,PC
Other - Org Name:PRUDENTIAL DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMASAT
Authorized Official - Middle Name:
Authorized Official - Last Name:GHEDDAF DAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, DRMEDDENT
Authorized Official - Phone:617-267-3889
Mailing Address - Street 1:575 BOYLSTON ST FL 7
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3607
Mailing Address - Country:US
Mailing Address - Phone:617-267-3889
Mailing Address - Fax:
Practice Address - Street 1:575 BOYLSTON ST FL 7
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3607
Practice Address - Country:US
Practice Address - Phone:617-267-3889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856379122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty