Miassar Abutabikh
Individual provider Active NPI Dentist · Boston, MA
NPI 1316701295 · NPPES record last updated Feb 21, 2025
Key facts
- NPI
- 1316701295
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN10000556 (MA)
- Practice address
- 635 Albany St
Boston, MA 02118-3550 - Phone
- (617) 358-8300
- NPI assigned
- Feb 12, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN10000556 | MA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN10000556 | MA | Yes |
Addresses
Primary practice location
635 Albany St
Boston, MA 02118-3550
Mailing address
334 Broadway
Revere, MA 02151-5016
Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.