Provider Demographics
NPI:1770177875
Name:AU BLANC PLLC
Entity type:Organization
Organization Name:AU BLANC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHAIB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-235-6616
Mailing Address - Street 1:1 HOLLIS ST STE 140
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-4690
Mailing Address - Country:US
Mailing Address - Phone:781-235-6616
Mailing Address - Fax:
Practice Address - Street 1:1 HOLLIS ST STE 140
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-4690
Practice Address - Country:US
Practice Address - Phone:781-235-6616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty