Provider Demographics
NPI:1861672750
Name:WAKEFIELD FAMILY DENTAL CENTER
Entity Type:Organization
Organization Name:WAKEFIELD FAMILY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-SHEIKH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-245-2566
Mailing Address - Street 1:211 ALBION ST.
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01180
Mailing Address - Country:US
Mailing Address - Phone:781-245-2566
Mailing Address - Fax:781-246-1999
Practice Address - Street 1:211 ALBION ST.
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01180
Practice Address - Country:US
Practice Address - Phone:781-245-2566
Practice Address - Fax:781-246-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20377122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty