Provider Demographics
NPI:1255748976
Name:ALGHANIM, MANAR (BDS)
Entity type:Individual
Prefix:MISS
First Name:MANAR
Middle Name:
Last Name:ALGHANIM
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KNEELAND ST 8TH FLOOR (PEDIATRIC DEPT.)
Mailing Address - Street 2:TUFTS DENTAL HOSPITAL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-636-6971
Mailing Address - Fax:617-636-3473
Practice Address - Street 1:1 KNEELAND ST 8TH FLOOR PEDIATRIC DEPARTMENT
Practice Address - Street 2:TUFTS DENTAL HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-6971
Practice Address - Fax:617-636-3473
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2015-02-18
Deactivation Date:2015-02-16
Deactivation Code:
Reactivation Date:2015-02-18
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADL12406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program