Organization
PROFESSIONAL DENTAL IMAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MUSTAFA ZAKKOOM DDS (DENTIST)
(248) 824-4916
Entity
Organization
Contact information
Practice address
53 BIGELOW AVE, WATERTOWN, MA 02472-2009
(248) 824-4916
Mailing address
770 BOYLSTON ST APT 15H, BOSTON, MA 02199-7713
(248) 824-4916
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN1856872
MA
Other
Enumeration date
10/23/2017
Last updated
10/23/2017
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