Provider Demographics
NPI:1558193961
Name:ALDURAIE, ALHANOOF
Entity type:Individual
Prefix:
First Name:ALHANOOF
Middle Name:
Last Name:ALDURAIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 E DEDHAM ST APT 308
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2656
Mailing Address - Country:US
Mailing Address - Phone:617-510-5402
Mailing Address - Fax:
Practice Address - Street 1:89 E DEDHAM ST APT 308
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2656
Practice Address - Country:US
Practice Address - Phone:617-510-5402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL159491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics