Organization
OMNI DENTIX & ASSOC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOHAMMED E MOBASHERAT D.M.D, D.D.S., (PRESIDENT)
(781) 396-6613
Entity
Organization
Contact information
Practice address
3850 MYSTIC VALLEY PKWY, SUITE 20, MEDFORD, MA 02155-6901
(781) 396-6613
(781) 395-4292
Mailing address
3850 MYSTIC VALLEY PKWY, SUITE 20, MEDFORD, MA 02155-6901
(781) 396-6613
(781) 395-4292
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
20309
MA
1223P0221X
Pediatric Dentistry
Primary
15376
MA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
13913
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0205401
—
MA
05
—
0263702
—
MA
05
—
0268361
—
MA
Enumeration date
06/27/2008
Last updated
06/27/2008
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