Provider Demographics
NPI:1487869277
Name:CANTON DENTAL GROUP
Entity type:Organization
Organization Name:CANTON DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHAZWAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GHAZI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-828-1788
Mailing Address - Street 1:608 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3032
Mailing Address - Country:US
Mailing Address - Phone:781-828-1788
Mailing Address - Fax:781-828-2788
Practice Address - Street 1:608 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3032
Practice Address - Country:US
Practice Address - Phone:781-828-1788
Practice Address - Fax:781-828-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty