Provider Demographics
NPI:1952846370
Name:EMB DENTAL, LLC
Entity Type:Organization
Organization Name:EMB DENTAL, LLC
Other - Org Name:SUDBURY DENTAL EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARHAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVI-SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-698-7245
Mailing Address - Street 1:15 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2328
Mailing Address - Country:US
Mailing Address - Phone:978-467-4999
Mailing Address - Fax:
Practice Address - Street 1:15 CONCORD RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-2328
Practice Address - Country:US
Practice Address - Phone:978-467-4999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN22191122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty