Provider Demographics
NPI:1457527814
Name:PLEASANT DENTAL CENTER, INC.
Entity Type:Organization
Organization Name:PLEASANT DENTAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABOU-EZZI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-869-3658
Mailing Address - Street 1:126A PLEASANT VALLEY ST STE 4
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-7217
Mailing Address - Country:US
Mailing Address - Phone:978-688-9200
Mailing Address - Fax:978-688-4949
Practice Address - Street 1:126A PLEASANT VALLEY ST STE 4
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-7217
Practice Address - Country:US
Practice Address - Phone:978-688-9200
Practice Address - Fax:978-688-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty