Provider Demographics
NPI:1679783575
Name:AFFORDABLE DENTAL CARE OF ATTLEBORO
Entity Type:Organization
Organization Name:AFFORDABLE DENTAL CARE OF ATTLEBORO
Other - Org Name:AFFORDABLE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HIKMAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNAWI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-222-2510
Mailing Address - Street 1:11 EMORY ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-3038
Mailing Address - Country:US
Mailing Address - Phone:508-226-2623
Mailing Address - Fax:
Practice Address - Street 1:11 EMORY STREET
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3038
Practice Address - Country:US
Practice Address - Phone:508-226-2623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19763122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA19763OtherALTUS DENTAL
MA19763OtherDELTA DENTAL OF MASS
MA0299961Medicaid
MA19763OtherCIGNA DENTAL
MA89461OtherDHA
MA19763OtherMETLIFE
MAX12424OtherBCBS OF MASS
MA19763OtherGURDIAN
MA19763OtherUNICARE
MA89461OtherDHA