Provider Demographics
NPI:1700198280
Name:SAADOUN, MANAL (BDS)
Entity Type:Individual
Prefix:
First Name:MANAL
Middle Name:
Last Name:SAADOUN
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 STATION LNDG
Mailing Address - Street 2:APT 201
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5127
Mailing Address - Country:US
Mailing Address - Phone:781-219-7996
Mailing Address - Fax:
Practice Address - Street 1:100 E. NEWTON STREET,
Practice Address - Street 2:7TH FLOOR BOSTON UNIVERSITY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:781-219-7996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL10987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist