Provider Demographics
NPI:1952676264
Name:NATICK DENTAL GROUP
Entity Type:Organization
Organization Name:NATICK DENTAL GROUP
Other - Org Name:PREMIER DENTAL ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MONAF
Authorized Official - Middle Name:
Authorized Official - Last Name:ALYASSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-318-6333
Mailing Address - Street 1:232 POND ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4366
Mailing Address - Country:US
Mailing Address - Phone:508-318-6333
Mailing Address - Fax:508-318-6338
Practice Address - Street 1:232 POND ST
Practice Address - Street 2:SUITE 5
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4366
Practice Address - Country:US
Practice Address - Phone:508-318-6333
Practice Address - Fax:508-318-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN206341223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty