Provider Demographics
NPI:1619072402
Name:MAHMOUD HADIDY DMD PC
Entity Type:Organization
Organization Name:MAHMOUD HADIDY DMD PC
Other - Org Name:WESTBOROUGH ORAL & MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ZOHNI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-366-8300
Mailing Address - Street 1:176 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581
Mailing Address - Country:US
Mailing Address - Phone:508-366-8300
Mailing Address - Fax:508-870-1848
Practice Address - Street 1:176 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-366-8300
Practice Address - Fax:508-870-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154691223G0001X
MA198411223G0001X
MA193531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty