Provider Demographics
NPI:1972762615
Name:MERRIMACK DENTAL ASSOC., PC
Entity type:Organization
Organization Name:MERRIMACK DENTAL ASSOC., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KINAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANBAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-263-2955
Mailing Address - Street 1:126A PLEASANT VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-7217
Mailing Address - Country:US
Mailing Address - Phone:978-682-0336
Mailing Address - Fax:978-683-1874
Practice Address - Street 1:126A PLEASANT VALLEY ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-7217
Practice Address - Country:US
Practice Address - Phone:978-682-0336
Practice Address - Fax:978-683-1874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19336122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty