Provider Demographics
NPI:1255793733
Name:ANIBABA, AINA WILLIAM (DDS, MBA)
Entity type:Individual
Prefix:
First Name:AINA
Middle Name:WILLIAM
Last Name:ANIBABA
Suffix:
Gender:M
Credentials:DDS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 UNION ST
Mailing Address - Street 2:2ND FLOOR DENTAL
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1314
Mailing Address - Country:US
Mailing Address - Phone:781-581-9832
Mailing Address - Fax:781-581-9583
Practice Address - Street 1:269 UNION ST
Practice Address - Street 2:2ND FLOOR DENTAL
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1314
Practice Address - Country:US
Practice Address - Phone:781-581-9832
Practice Address - Fax:781-581-9583
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL12833122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist