Provider Demographics
NPI:1952706251
Name:MAYANI DENTAL GROUP LLC
Entity Type:Organization
Organization Name:MAYANI DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-330-8887
Mailing Address - Street 1:1 INTERNATIONAL PL FL 7
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-2602
Mailing Address - Country:US
Mailing Address - Phone:617-330-8887
Mailing Address - Fax:617-330-8730
Practice Address - Street 1:1 INTERNATIONAL PL FL 7
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-2602
Practice Address - Country:US
Practice Address - Phone:617-330-8887
Practice Address - Fax:617-330-8730
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JENNY CHANG, DMD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN195831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty