Provider Demographics
NPI:1558991778
Name:ASHLAND ELITE DENTAL PLLC
Entity Type:Organization
Organization Name:ASHLAND ELITE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSABNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-797-5094
Mailing Address - Street 1:171 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1190
Mailing Address - Country:US
Mailing Address - Phone:508-838-7551
Mailing Address - Fax:
Practice Address - Street 1:171 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MA
Practice Address - Zip Code:01721-1190
Practice Address - Country:US
Practice Address - Phone:508-881-1280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty