Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | DL14755 | MA |
Y | 1223G0001X | General Practice | DL14755 | MA |
Y | 213EG0000X | General Practice | DL14755 | MA |
NPI | 1023685179 |
---|---|
Provider Name | Dr. Abdullrahman Alghamdi |
First Address | Boston, MA 02118 |
Second Address | Boston, MA 02118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2021 |
Last Update Date | 01/07/2021 |