Provider Demographics
NPI:1548542681
Name:BEDFORD DENTAL ARTS, LLC
Entity type:Organization
Organization Name:BEDFORD DENTAL ARTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WASSEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL ATTAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-258-5039
Mailing Address - Street 1:41 NORTH RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1037
Mailing Address - Country:US
Mailing Address - Phone:781-275-2556
Mailing Address - Fax:781-275-2273
Practice Address - Street 1:18 WESTFORD ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:MA
Practice Address - Zip Code:01741-1506
Practice Address - Country:US
Practice Address - Phone:978-369-7967
Practice Address - Fax:781-275-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAD18871122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA18871OtherLICENSE NUMBER