Provider Demographics
NPI:1346725447
Name:HUSSAIN, SYED SHAZIL (DMD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:SHAZIL
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 RESERVOIR ST STE 9
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3133
Mailing Address - Country:US
Mailing Address - Phone:781-400-5920
Mailing Address - Fax:617-863-2036
Practice Address - Street 1:220 RESERVOIR ST STE 9
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3133
Practice Address - Country:US
Practice Address - Phone:781-400-5920
Practice Address - Fax:617-863-2036
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38022122300000X
MADN1858134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist