Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 18604 | MA |
NPI | 1114233319 |
---|---|
Provider Name | Dr. Fayez George Badlissi |
First Address | Attleboro, MA 02703-1735 |
Second Address | Attleboro, MA 02703-1735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2010 |
Last Update Date | 25/08/2010 |