Provider Demographics
NPI:1376927848
Name:WORCESTER DENTIST GROUP PC
Entity Type:Organization
Organization Name:WORCESTER DENTIST GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BASH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-526-5042
Mailing Address - Street 1:255 PARK AVE STE 804
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1984
Mailing Address - Country:US
Mailing Address - Phone:508-755-6359
Mailing Address - Fax:508-459-5277
Practice Address - Street 1:255 PARK AVE STE 804
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1984
Practice Address - Country:US
Practice Address - Phone:508-755-6359
Practice Address - Fax:508-459-5277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty