Evette Tadros Bakhit, MOD
Individual provider Active NPI General Practice Dentistry · Medway, MA
NPI 1184635658 · NPPES record last updated Mar 25, 2015
Key facts
- NPI
- 1184635658
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 17758 (MA)
- Practice address
- 113 Main St
Medway, MA 02053-1802 - Phone
- (508) 533-7890
- Fax
- (508) 533-7890
- NPI assigned
- Aug 10, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150813010274 | MA | Order and Referring Only - Dentist |
5294040754 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17758 | MA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Mark Dental PC | General Practice | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 17758 | MA | Yes |
Addresses
Primary practice location
113 Main St
Medway, MA 02053-1802
Mailing address
113 Main St
Medway, MA 02053-1802
Phone (508) 533-7890
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0273201 | Medicaid | MA |
Other providers in Medway, MA
- Danielle N Allen
- Susan Apicella
- Milan Artis
- Jeffrey Ayotte
- Sydney Baker
- Lauren Barakian
- Donna L. Barry Moilanen
- Susannah Hollis Barry
- Shannon Beck
- Chelsea Bengyak
All providers in Medway, MA · General Practice Dentistry in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.