Provider Demographics
NPI:1437658226
Name:IHAM GAMMAS DMD LLC
Entity Type:Organization
Organization Name:IHAM GAMMAS DMD LLC
Other - Org Name:LOWELL FAMILY DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-458-1179
Mailing Address - Street 1:263 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-4506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:133 MARKET ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-6249
Practice Address - Country:US
Practice Address - Phone:978-458-1179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental