Individual provider Active NPI

Hamasat Gheddaf Dam, D.M.D

  • Dentist
  • Boston, MA
National Provider Identifier
1639368236
Registry record updated Oct 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
9769 Issued in MA
Practice address
188 Longwood Ave
Restorative Dentistry & Biological Sciences
Boston, MA 02115-5819
Phone
(617) 432-1474
Fax
(617) 432-0901
NPI assigned
Oct 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 9769 MA Primary

Addresses

Primary practice location

188 Longwood Ave
Restorative Dentistry & Biological Sciences
Boston, MA 02115-5819

Mailing address

188 Longwood Ave
Restorative Dentistry & Biological Sciences
Boston, MA 02115-5819
Phone (617) 432-1474

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
9769MAMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192665600000",
    "number": "1639368236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188 LONGWOOD AVE",
            "address_2": "RESTORATIVE DENTISTRY & BIOLOGICAL SCIENCES",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155819",
            "telephone_number": "617-432-1474",
            "fax_number": "617-432-0901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 LONGWOOD AVE",
            "address_2": "RESTORATIVE DENTISTRY & BIOLOGICAL SCIENCES",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021155819",
            "telephone_number": "617-432-1474",
            "fax_number": "617-432-0901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHEDDAF DAM",
        "first_name": "HAMASAT",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-18",
        "last_updated": "2007-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "9769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2007; 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.