Provider Demographics
NPI:1750886685
Name:AMERICAN DENTAL OF WATERTOWN
Entity type:Organization
Organization Name:AMERICAN DENTAL OF WATERTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAIF
Authorized Official - Middle Name:
Authorized Official - Last Name:NAJI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-467-5113
Mailing Address - Street 1:171 WATERTOWN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2571
Mailing Address - Country:US
Mailing Address - Phone:617-467-5113
Mailing Address - Fax:
Practice Address - Street 1:171 WATERTOWN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2571
Practice Address - Country:US
Practice Address - Phone:617-467-5113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855991261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental