Provider Demographics
NPI:1538824875
Name:SUDBURY DENTAL ARTS PC
Entity type:Organization
Organization Name:SUDBURY DENTAL ARTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ALAA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-596-6323
Mailing Address - Street 1:5 KERRIGAN WAY
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-4043
Mailing Address - Country:US
Mailing Address - Phone:617-596-6323
Mailing Address - Fax:
Practice Address - Street 1:144 NORTH RD STE 2125
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-1171
Practice Address - Country:US
Practice Address - Phone:617-596-6323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental