Provider Demographics
NPI:1750489431
Name:MEHANNA, ROBERT (DMD CAGS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:MEHANNA
Suffix:
Gender:M
Credentials:DMD CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 MAIN ST SUITE 203
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890
Mailing Address - Country:US
Mailing Address - Phone:781-729-9390
Mailing Address - Fax:
Practice Address - Street 1:955 MAIN ST SUITE 203
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890
Practice Address - Country:US
Practice Address - Phone:781-729-9390
Practice Address - Fax:781-729-6792
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202401223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics