Provider Demographics
NPI:1710385539
Name:ABOUKHATER, JOHN (DMD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:ABOUKHATER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:MR
Other - First Name:HASSAN
Other - Middle Name:
Other - Last Name:ABOUKHATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:210 BELMONT STREET APT 5
Mailing Address - Street 2:
Mailing Address - City:EAST WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3557
Mailing Address - Country:US
Mailing Address - Phone:978-372-9122
Mailing Address - Fax:978-372-6131
Practice Address - Street 1:215 SUMMER STREET
Practice Address - Street 2:SUITE 11
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830
Practice Address - Country:US
Practice Address - Phone:978-372-9122
Practice Address - Fax:978-372-6131
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18670122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist