Provider Demographics
NPI:1669023958
Name:NACHAWATI, AHMAD (DMD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:NACHAWATI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PADDOCK LN APT 3305
Mailing Address - Street 2:
Mailing Address - City:BOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01719-1774
Mailing Address - Country:US
Mailing Address - Phone:714-260-3083
Mailing Address - Fax:
Practice Address - Street 1:31 CINEMA BLVD
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3290
Practice Address - Country:US
Practice Address - Phone:978-230-0744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18584931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice