Provider Demographics
NPI:1174099949
Name:HOLBROOK DENTAL GROUP, P.C.
Entity type:Organization
Organization Name:HOLBROOK DENTAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAKI
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MUKDISSI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-386-9834
Mailing Address - Street 1:8 JEWEL RD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-1506
Mailing Address - Country:US
Mailing Address - Phone:781-767-1300
Mailing Address - Fax:781-961-3090
Practice Address - Street 1:8 JEWEL RD
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:MA
Practice Address - Zip Code:02343-1506
Practice Address - Country:US
Practice Address - Phone:781-767-1300
Practice Address - Fax:781-961-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty