Provider Demographics
NPI:1699093344
Name:WALID BEN AISSA DMD PA
Entity type:Organization
Organization Name:WALID BEN AISSA DMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALID
Authorized Official - Middle Name:
Authorized Official - Last Name:BEN AISSA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-928-9299
Mailing Address - Street 1:796 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1935
Mailing Address - Country:US
Mailing Address - Phone:617-928-9299
Mailing Address - Fax:617-928-0110
Practice Address - Street 1:796 BEACON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1935
Practice Address - Country:US
Practice Address - Phone:617-928-9299
Practice Address - Fax:617-928-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental