Provider Demographics
NPI:1720684079
Name:MAYANI DENTAL WATERTOWN LLC
Entity Type:Organization
Organization Name:MAYANI DENTAL WATERTOWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-784-7884
Mailing Address - Street 1:6 MOUNT AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3928
Mailing Address - Country:US
Mailing Address - Phone:617-755-1377
Mailing Address - Fax:
Practice Address - Street 1:6 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3928
Practice Address - Country:US
Practice Address - Phone:617-755-1377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty