Provider Demographics
NPI:1518470806
Name:GREENWOOD DENTAL BURLINGTON
Entity Type:Organization
Organization Name:GREENWOOD DENTAL BURLINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELREHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-328-1570
Mailing Address - Street 1:14 MOUNTAIN LAURELS DR APT 403
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-2370
Mailing Address - Country:US
Mailing Address - Phone:978-390-1968
Mailing Address - Fax:
Practice Address - Street 1:62 2ND AVE STE E
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4432
Practice Address - Country:US
Practice Address - Phone:781-328-1570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty