Provider Demographics
NPI:1619172616
Name:LAWRENCE DENTAL CENTER
Entity Type:Organization
Organization Name:LAWRENCE DENTAL CENTER
Other - Org Name:SMILES DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAJD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-685-8600
Mailing Address - Street 1:343 ESSEX ST
Mailing Address - Street 2:343 ESSEX ST
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1410
Mailing Address - Country:US
Mailing Address - Phone:978-685-8600
Mailing Address - Fax:978-687-3311
Practice Address - Street 1:343 ESSEX ST
Practice Address - Street 2:343 ESSEX ST
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1410
Practice Address - Country:US
Practice Address - Phone:978-685-8600
Practice Address - Fax:978-687-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20306122300000X
MA20320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9198693Medicare ID - Type Unspecified
MA9198692Medicare ID - Type Unspecified