Provider Demographics
NPI:1750479739
Name:KAYALI, MOHAMED (DMD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:KAYALI
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 1:333 RICCIUTI DR
Mailing Address - Street 2:APT. 2318
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6287
Mailing Address - Country:US
Mailing Address - Phone:617-642-7265
Mailing Address - Fax:
Practice Address - Street 1:333 RICCIUTI DR
Practice Address - Street 2:APT. 2318
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-6287
Practice Address - Country:US
Practice Address - Phone:617-642-7265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210011223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics