Provider Demographics
NPI:1538320684
Name:BOSTON UNIVERSITY SCHOOL OF DENTAL MEDCINE
Entity Type:Organization
Organization Name:BOSTON UNIVERSITY SCHOOL OF DENTAL MEDCINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTOLOGY RESIDANT
Authorized Official - Prefix:
Authorized Official - First Name:RAYYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAYAL
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:617-638-4750
Mailing Address - Street 1:160 PLEASANT ST
Mailing Address - Street 2:APT # 809
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4832
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 E NEWTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2308
Practice Address - Country:US
Practice Address - Phone:617-638-4750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9800282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital