Provider Demographics
NPI:1912277963
Name:QUINCY HIGH CARE DENTISTRY
Entity Type:Organization
Organization Name:QUINCY HIGH CARE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOATAZ
Authorized Official - Middle Name:MOHAMMED
Authorized Official - Last Name:SHABAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:862-588-6574
Mailing Address - Street 1:67 CODDINGTON ST
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4511
Mailing Address - Country:US
Mailing Address - Phone:862-588-6574
Mailing Address - Fax:
Practice Address - Street 1:67 CODDINGTON ST
Practice Address - Street 2:SUITE LL1
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4511
Practice Address - Country:US
Practice Address - Phone:862-588-6574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN22158261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental