PROFESSIONAL DENTAL IMAGE (NPI# 1881105484) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881105484 |
| Entity Type | Organization |
| Organization Name | PROFESSIONAL DENTAL IMAGE |
| Practice Address |
53 Bigelow Ave Watertown MA 02472-2009 |
| Mailing Address |
770 Boylston St Apt 15h Boston MA 02199-7713 |
| Practice Telephone | 2488244916 |
| Mailing Telephone | 2488244916 |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2017-10-23 |
| Authorized Official Name | MUSTAFA ZAKKOOM (DENTIST) |
| Authorized Official Telephone | 2488244916 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
DN1856872 | MA | Ambulatory Health Care Facilities |
| Street Address |
53 BIGELOW AVE |
| City | WATERTOWN |
| State | MA |
| Zip Code | 02472-2009 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669577888 | Professional Dental Image Corp | Dentist | 53 Bigelow Ave, Watertown, MA 02472 | 2006-09-13 |
| 1700071727 | Juan Jose Graham | Dentist | 53 Bigelow Ave, Watertown, MA 02472 | 2007-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548735327 | Gladys Nakungu Kasansula | Counselor | Square Medical Group, 124 Watertown Street, Suite 2d, Watertown, MA 02472 | 2018-10-09 |
| 1447741962 | Hannah Edward | Optometrist | 550 Arsenal Street, Watertown, MA 02472 | 2018-05-21 |
| 1982193504 | Ruth Audrey Silverstein | Social Worker | Perkins School for The Blind, 175 North Beacon Street, Watertown, MA 02472 | 2018-05-09 |
| 1376067355 | Mostafa Medhati | Acupuncturist | 265 Lexington St., Watertown, MA 02472 | 2017-08-01 |
| 1003346313 | Eric Trant | Specialist/Technologist | 50 Columbia Street, Watertown, MA 02472 | 2017-06-19 |
| 1477007730 | Neangkanika Chea | Nurse Practitioner | 2 Repton Place, Apt 2204, Watertown, MA 02472 | 2016-08-04 |
| 1396128120 | Michelle Soares Darocha | Dentist | 18 Hovey Street, Watertown, MA 02472 | 2015-06-29 |
| 1760875496 | Ece Evin Yildirim | Acupuncturist | 557 Mt. Auburn St, Watertown, MA 02472 | 2015-03-05 |
| 1396140927 | Fabrizia Torazzi | Behavioral Analyst | 51 Water Street, Suite 200, Watertown, MA 02472 | 2014-10-24 |
| 1265774392 | Emilia Ann Fulop | Social Worker | 127 North Beacon Street, Watertown, MA 02472 | 2013-03-27 |
| Find all providers in zip 02472 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356955868 | Todd A Brewer Dds Pllc | Clinic/Center | 603 Jefferson Ave Sw, Watertown, MN 55388 | 2020-09-02 |
| 1013382852 | Great Beginnings Pediatric Dentistry Pllc | Clinic/Center | 127 Winslow St, Watertown, NY 13601-4389 | 2015-12-04 |
| 1750911566 | Infinity Implant and Sedation LLC | Clinic/Center | 2310 9th Ave Se, Watertown, SD 57201-7112 | 2020-01-21 |
| 1982250726 | 42 North Dental Care, LLC | Clinic/Center | 21 Main St, Watertown, MA 02472-4403 | 2019-08-16 |
| 1487118188 | Luminous Dental LLC | Clinic/Center | 63 Mount Auburn St, Watertown, MA 02472-3924 | 2019-01-27 |
| 1285106831 | Watertown Dental Care, Pllc | Clinic/Center | 600 4th St Ne Ste 207, Watertown, SD 57201-1898 | 2018-12-20 |
| 1750886685 | American Dental of Watertown | Clinic/Center | 171 Watertown St, Watertown, MA 02472-2571 | 2018-03-23 |
| 1881103182 | Community Dentistry & Dentures, LLC | Clinic/Center | 324 4th St Ne, Watertown, SD 57201-2620 | 2017-09-29 |
| 1992246458 | Masi Dental Group PC | Clinic/Center | 171 Watertown St, Watertown, MA 02472-2571 | 2017-03-16 |
| 1790930154 | Pediatric Dental Arts | Clinic/Center | 521 Mount Auburn St, Suite 104, Watertown, MA 02472-4191 | 2008-11-25 |
| Find all providers in WATERTOWN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.