Provider Demographics
NPI:1760049761
Name:SIMPLY DENTAL OF WORCESTER SOUTH PLLC
Entity Type:Organization
Organization Name:SIMPLY DENTAL OF WORCESTER SOUTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALKHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-686-7220
Mailing Address - Street 1:87 ELM ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1638
Mailing Address - Country:US
Mailing Address - Phone:508-686-7220
Mailing Address - Fax:
Practice Address - Street 1:10 WINTHROP STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604
Practice Address - Country:US
Practice Address - Phone:508-756-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty