Provider Demographics
NPI:1548750326
Name:PATRIOT FAMILY DENTAL
Entity Type:Organization
Organization Name:PATRIOT FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEHRUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMASSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-440-4971
Mailing Address - Street 1:543 KELLEY BVLD
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760
Mailing Address - Country:US
Mailing Address - Phone:508-316-3458
Mailing Address - Fax:508-316-3069
Practice Address - Street 1:543 KELLEY BVLD
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760
Practice Address - Country:US
Practice Address - Phone:508-316-3458
Practice Address - Fax:508-316-3069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN19816261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental