Provider Demographics
NPI:1588111389
Name:BUKHARI, ALAA
Entity type:Individual
Prefix:
First Name:ALAA
Middle Name:
Last Name:BUKHARI
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 1:75 STATION LNDG
Mailing Address - Street 2:#526
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5127
Mailing Address - Country:US
Mailing Address - Phone:857-272-4535
Mailing Address - Fax:
Practice Address - Street 1:75 STATION LNDG
Practice Address - Street 2:#526
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5127
Practice Address - Country:US
Practice Address - Phone:857-272-4535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL13039125Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125Q00000XDental ProvidersDentistOral Medicine