| Organization Name: | MAYNARD DENTAL ASSOCIATES, LLC |
| NPI Number: | 1811273378 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALEXANDER J MOHEBAN (OWNER) |
| Mailing Address: | 63 Great Rd Suite 105 Maynard |
| State: | MA US |
| Postal Code: | 017542097 |
| Phone Number: | 9782985281 |
| Fax Number: | 9782985364 |
| NPI Enumeration Date: | 10/28/2011 |
| NPI Last Update Date: | 10/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | DN1855167 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |