Provider Demographics
NPI:1497460331
Name:S & Y DENTAL PC
Entity Type:Organization
Organization Name:S & Y DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHADI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMEKKAWI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:754-234-6971
Mailing Address - Street 1:576 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-7130
Mailing Address - Country:US
Mailing Address - Phone:754-234-6971
Mailing Address - Fax:
Practice Address - Street 1:576 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-7130
Practice Address - Country:US
Practice Address - Phone:754-234-6971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental