Provider Demographics
NPI:1871761353
Name:MAHA G BOUTROS, DMD, PC
Entity type:Organization
Organization Name:MAHA G BOUTROS, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOUTROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-256-4551
Mailing Address - Street 1:1 MEETING HOUSE RD
Mailing Address - Street 2:SUITE # 4
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2733
Mailing Address - Country:US
Mailing Address - Phone:978-256-4551
Mailing Address - Fax:
Practice Address - Street 1:1 MEETING HOUSE RD
Practice Address - Street 2:SUITE # 4
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2733
Practice Address - Country:US
Practice Address - Phone:978-256-4551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty