Provider Demographics
NPI:1437582657
Name:METROPOLITAN ORTHODONTICS, PC
Entity Type:Organization
Organization Name:METROPOLITAN ORTHODONTICS, PC
Other - Org Name:LOWELL BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALKHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-505-5040
Mailing Address - Street 1:19 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1220
Mailing Address - Country:US
Mailing Address - Phone:508-505-5040
Mailing Address - Fax:
Practice Address - Street 1:40 NOUVELLE WAY
Practice Address - Street 2:C/O SAM ALKHOURY N349
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1571
Practice Address - Country:US
Practice Address - Phone:508-505-5040
Practice Address - Fax:508-306-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN205111223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty