# MELROSE FAMILY DENTAL PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942751953
- **Authorized official:** DR. ALAAEDDIN ALWAZZAN DMD, FACP (OWNER)
- **Authorized official phone:** (617) 669-9839

## Contact information

- **Practice address:** 12 PORTER ST, MELROSE, MA 02176-2810
- **Practice address phone:** (781) 665-1552
- **Mailing address:** 12 PORTER ST, MELROSE, MA 02176-2810
- **Mailing address phone:** (781) 665-1552

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DN13354 | MA | — |
| 122300000X | Dentist | DN1855140 | MA | — |
| 1223P0700X | Prosthodontics | DN22162 | MA | Yes |

## Other

- **Enumeration date:** 10/14/2016
- **Last updated:** 10/14/2016