Provider Demographics
NPI:1255180295
Name:NASSER, EYAD
Entity type:Individual
Prefix:
First Name:EYAD
Middle Name:
Last Name:NASSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MHD
Other - Middle Name:IEAD
Other - Last Name:NASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1850
Mailing Address - Country:US
Mailing Address - Phone:617-427-4242
Mailing Address - Fax:
Practice Address - Street 1:333 WARREN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02119-1850
Practice Address - Country:US
Practice Address - Phone:617-427-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN10000278122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program