Provider Demographics
NPI:1710383674
Name:UNIQUE DENTAL
Entity Type:Organization
Organization Name:UNIQUE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ZYOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-753-5488
Mailing Address - Street 1:1438 GRAFTON ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-2721
Mailing Address - Country:US
Mailing Address - Phone:508-753-5488
Mailing Address - Fax:
Practice Address - Street 1:1438 GRAFTON ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-2721
Practice Address - Country:US
Practice Address - Phone:508-753-5488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty