Provider Demographics
NPI:1588824056
Name:MAWARDI, HANI HAYTHAM (BDS, DMSC)
Entity Type:Individual
Prefix:DR
First Name:HANI
Middle Name:HAYTHAM
Last Name:MAWARDI
Suffix:
Gender:M
Credentials:BDS, DMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 TREMONT ST
Mailing Address - Street 2:APT 9N
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1125
Mailing Address - Country:US
Mailing Address - Phone:857-277-3013
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:DIVISION OF ORAL MEDICINE AND DENTISTRY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:857-277-3013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9636122300000X
MADF10727122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist