Provider Demographics
NPI:1861689309
Name:GAMMAS, IHAM (DMD)
Entity Type:Individual
Prefix:
First Name:IHAM
Middle Name:
Last Name:GAMMAS
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 1:263 HUNTINGTON AVE
Mailing Address - Street 2:146
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-4506
Mailing Address - Country:US
Mailing Address - Phone:617-710-5072
Mailing Address - Fax:
Practice Address - Street 1:550 N MAIN ST
Practice Address - Street 2:A
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-1735
Practice Address - Country:US
Practice Address - Phone:508-222-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21981122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist