Provider Demographics
NPI:1639329121
Name:AL-AWADHI, BADER A (DDS)
Entity type:Individual
Prefix:
First Name:BADER
Middle Name:A
Last Name:AL-AWADHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 DARTMOUTH ST
Mailing Address - Street 2:APT. #315
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5118
Mailing Address - Country:US
Mailing Address - Phone:781-654-6773
Mailing Address - Fax:
Practice Address - Street 1:130 DARTMOUTH STREET #315
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116
Practice Address - Country:US
Practice Address - Phone:781-654-6773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA97021223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics