Provider Demographics
NPI:1194580522
Name:RAYNHAM DENTAL PARTNERS LLC
Entity type:Organization
Organization Name:RAYNHAM DENTAL PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMAD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:248-421-9814
Mailing Address - Street 1:65 SAMOSET DR
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-4699
Mailing Address - Country:US
Mailing Address - Phone:248-421-9814
Mailing Address - Fax:
Practice Address - Street 1:1244 BROADWAY
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-1973
Practice Address - Country:US
Practice Address - Phone:508-880-4910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty