Provider Demographics
NPI:1174221311
Name:GREAT DENTAL CLINIC PC
Entity type:Organization
Organization Name:GREAT DENTAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKWATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-704-6741
Mailing Address - Street 1:77 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:WINCHENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01475-1609
Mailing Address - Country:US
Mailing Address - Phone:978-297-0675
Mailing Address - Fax:
Practice Address - Street 1:77 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:WINCHENDON
Practice Address - State:MA
Practice Address - Zip Code:01475-1609
Practice Address - Country:US
Practice Address - Phone:978-297-0675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental