Provider Demographics
NPI:1831670678
Name:ULTIMATE DENTAL CARE OF RANDOLPH , PC
Entity Type:Organization
Organization Name:ULTIMATE DENTAL CARE OF RANDOLPH , PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLOUM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-963-9200
Mailing Address - Street 1:3 LT ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1372
Mailing Address - Country:US
Mailing Address - Phone:781-963-9200
Mailing Address - Fax:
Practice Address - Street 1:1110 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2132
Practice Address - Country:US
Practice Address - Phone:617-462-8728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty