Provider Demographics
NPI:1588781587
Name:ELIAS K BADRAN DMD PC
Entity type:Organization
Organization Name:ELIAS K BADRAN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:KHALIL
Authorized Official - Last Name:BADRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-335-2585
Mailing Address - Street 1:73 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190
Mailing Address - Country:US
Mailing Address - Phone:781-335-2585
Mailing Address - Fax:781-335-7882
Practice Address - Street 1:73 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190
Practice Address - Country:US
Practice Address - Phone:781-335-2585
Practice Address - Fax:781-335-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA192281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty