Provider Demographics
NPI:1922522747
Name:PROSTHODONTIC ASSOCIATES PC
Entity Type:Organization
Organization Name:PROSTHODONTIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALID
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEHNI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-246-2211
Mailing Address - Street 1:50 SALEM ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940
Mailing Address - Country:US
Mailing Address - Phone:781-246-2211
Mailing Address - Fax:
Practice Address - Street 1:50 SALEM ST.
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940
Practice Address - Country:US
Practice Address - Phone:781-246-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA185541223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty