Provider Demographics
NPI:1841350329
Name:BEDFORD DENTAL ARTS LLC
Entity type:Organization
Organization Name:BEDFORD DENTAL ARTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WASSEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL ATTAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-275-6365
Mailing Address - Street 1:41 NORTH RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1037
Mailing Address - Country:US
Mailing Address - Phone:781-275-6365
Mailing Address - Fax:781-275-2273
Practice Address - Street 1:41 NORTH RD
Practice Address - Street 2:SUITE 207
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1037
Practice Address - Country:US
Practice Address - Phone:781-275-6365
Practice Address - Fax:781-275-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty