Provider Demographics
NPI:1598274235
Name:MAYANI DENTAL BRIGHTON
Entity Type:Organization
Organization Name:MAYANI DENTAL BRIGHTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-783-1822
Mailing Address - Street 1:60 LEO M BIRMINGHAM PKWY
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1123
Mailing Address - Country:US
Mailing Address - Phone:617-783-1822
Mailing Address - Fax:
Practice Address - Street 1:60 LEO M BIRMINGHAM PKWY
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1123
Practice Address - Country:US
Practice Address - Phone:617-783-1822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19583261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental