Provider Demographics
NPI:1124293402
Name:NEW ENGLAND DENTAL ASSOCIATES
Entity type:Organization
Organization Name:NEW ENGLAND DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-541-6886
Mailing Address - Street 1:500 FRANKLIN VILLAGE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-4017
Mailing Address - Country:US
Mailing Address - Phone:508-541-6886
Mailing Address - Fax:
Practice Address - Street 1:500 FRANKLIN VILLAGE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-4017
Practice Address - Country:US
Practice Address - Phone:508-541-6886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202721223E0200X
MA177971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty