Provider Demographics
NPI:1922315910
Name:SCITUATE PERIODONTICS LLC
Entity Type:Organization
Organization Name:SCITUATE PERIODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,BDS,MS,FICD
Authorized Official - Phone:781-545-7800
Mailing Address - Street 1:56 NEW DRIFTWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-4533
Mailing Address - Country:US
Mailing Address - Phone:781-545-7800
Mailing Address - Fax:781-545-7801
Practice Address - Street 1:56 NEW DRIFTWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4533
Practice Address - Country:US
Practice Address - Phone:781-545-7800
Practice Address - Fax:781-545-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-12
Last Update Date:2010-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209881223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty