Provider Demographics
NPI:1275856494
Name:WATERTOWN DENTISTRY
Entity Type:Organization
Organization Name:WATERTOWN DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUSRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-600-3442
Mailing Address - Street 1:51A GALEN STREET
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472
Mailing Address - Country:US
Mailing Address - Phone:617-600-3442
Mailing Address - Fax:617-600-3448
Practice Address - Street 1:51A GALEN STREET
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472
Practice Address - Country:US
Practice Address - Phone:617-600-3442
Practice Address - Fax:617-600-3448
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHELSEA FAMILY DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19968122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty