Provider Demographics
NPI:1609400035
Name:MEDFORD FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:MEDFORD FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:SUHIL
Authorized Official - Last Name:ZAHKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-913-0519
Mailing Address - Street 1:101 MAIN ST STE 220
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4530
Mailing Address - Country:US
Mailing Address - Phone:617-913-0519
Mailing Address - Fax:
Practice Address - Street 1:101 MAIN ST STE 220
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4530
Practice Address - Country:US
Practice Address - Phone:617-913-0519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental