Provider Demographics
NPI:1861898827
Name:RANIA S. MEHANNA DMD PC
Entity type:Organization
Organization Name:RANIA S. MEHANNA DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PC
Authorized Official - Prefix:DR
Authorized Official - First Name:RANIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-337-0500
Mailing Address - Street 1:312 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02191-1124
Mailing Address - Country:US
Mailing Address - Phone:781-337-0500
Mailing Address - Fax:781-337-0527
Practice Address - Street 1:312 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:NORTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02191-1124
Practice Address - Country:US
Practice Address - Phone:781-337-0500
Practice Address - Fax:781-337-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20969261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA=========OtherTIN