Provider Demographics
NPI:1649829110
Name:SKY DENTAL PC
Entity type:Organization
Organization Name:SKY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MIHYAWI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-780-5045
Mailing Address - Street 1:2 HANCOCK ST APT 728
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1766
Mailing Address - Country:US
Mailing Address - Phone:617-780-5045
Mailing Address - Fax:
Practice Address - Street 1:70 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5014
Practice Address - Country:US
Practice Address - Phone:781-338-0818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty