Southborough Dental Partners PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

18504 Issued in MA

Legal business name

SOUTHBOROUGH DENTAL PARTNERS PLLC

Practice address

21 Turnpike Rd
Suite F
Southborough, MA 01772-2117

Phone

(508) 357-8800

Fax

(508) 624-0191

NPI assigned

Apr 14, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Husam Al-Khateeb, DMD

Title

Dentist (Owner)

Phone

(617) 571-4992

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568764800000",
    "number": "1053585869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 TURNPIKE RD",
            "address_2": "SUITE F",
            "city": "SOUTHBOROUGH",
            "state": "MA",
            "postal_code": "017722117",
            "telephone_number": "508-357-8800",
            "fax_number": "508-624-0191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 TURNPIKE RD",
            "address_2": "SUITE F",
            "city": "SOUTHBOROUGH",
            "state": "MA",
            "postal_code": "017722117",
            "telephone_number": "508-357-8800",
            "fax_number": "508-624-0191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHBOROUGH DENTAL PARTNERS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-14",
        "last_updated": "2019-09-18",
        "status": "A",
        "authorized_official_last_name": "AL-KHATEEB",
        "authorized_official_first_name": "HUSAM",
        "authorized_official_title_or_position": "DENTIST (OWNER)",
        "authorized_official_telephone_number": "617-571-4992",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MA",
            "license": "18504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southboro Medical Group, Inc
• Southboro Medical Group, Inc.
• Southboro Medical Group, Inc.
• Southboro Medical Group, Inc.
• Southborough Dental Associates LLP
• Southborough Dentistry PC
• Judy Southey
• Lisa W Spellman, LIC. AC.
• Emily Vittal Srinivasaragavan
• Liv Meier Steen

• Dental Clinic/Center in Southborough, MA
• Providers in Southborough, MA by specialty
• Dental Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.