Provider Demographics
NPI:1124299391
Name:LINA AL-ASWAD , DMD, PC
Entity type:Organization
Organization Name:LINA AL-ASWAD , DMD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:AL-ASWAD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-625-3636
Mailing Address - Street 1:1133 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1826
Mailing Address - Country:US
Mailing Address - Phone:617-625-3636
Mailing Address - Fax:617-625-6997
Practice Address - Street 1:1133 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1826
Practice Address - Country:US
Practice Address - Phone:617-625-3636
Practice Address - Fax:617-625-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19750261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0297968OtherMASSHEALTH