Provider Demographics
NPI:1639682305
Name:BOSTON DENTAL PARTNERS LLC
Entity Type:Organization
Organization Name:BOSTON DENTAL PARTNERS LLC
Other - Org Name:WASHINGTON PARK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-904-1530
Mailing Address - Street 1:330 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1868
Mailing Address - Country:US
Mailing Address - Phone:508-904-1530
Mailing Address - Fax:
Practice Address - Street 1:330 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02119-1868
Practice Address - Country:US
Practice Address - Phone:508-904-1530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856303261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841632213OtherNPI