Provider Demographics
NPI:1982872362
Name:ALI NASSEH, DDS, PC
Entity Type:Organization
Organization Name:ALI NASSEH, DDS, PC
Other - Org Name:MICROSURGICAL ENDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:P
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-236-7818
Mailing Address - Street 1:575 BOYLSTON ST
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3607
Mailing Address - Country:US
Mailing Address - Phone:617-236-7818
Mailing Address - Fax:617-236-7811
Practice Address - Street 1:575 BOYLSTON ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3607
Practice Address - Country:US
Practice Address - Phone:617-236-7818
Practice Address - Fax:617-236-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA185941223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty