Provider Demographics
NPI:1568680205
Name:AK DENTAL PRACTICE PC
Entity Type:Organization
Organization Name:AK DENTAL PRACTICE PC
Other - Org Name:GOLDSTONE,KHALIL & ASSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:AHED
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-491-1403
Mailing Address - Street 1:20 HURLEY ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-2111
Mailing Address - Country:US
Mailing Address - Phone:617-491-1403
Mailing Address - Fax:617-491-5648
Practice Address - Street 1:20 HURLEY ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-2111
Practice Address - Country:US
Practice Address - Phone:617-491-1403
Practice Address - Fax:617-491-5648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty