Basic Information
Provider Information
NPI: 1366775249
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALBLOWI
FirstName: JAZIA
MiddleName: ABDULLAH
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 E NEWTON ST
Address2:  
City: BOSTON
State: MA
PostalCode: 021182308
CountryCode: US
TelephoneNumber: 6176384750
FaxNumber: 6176386170
Practice Location
Address1: 100 E NEWTON ST
Address2:  
City: BOSTON
State: MA
PostalCode: 021182308
CountryCode: US
TelephoneNumber: 6176384750
FaxNumber: 6176386170
Other Information
ProviderEnumerationDate: 09/10/2009
LastUpdateDate: 09/10/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223P0300XDL10746MAY Dental ProvidersDentistPeriodontics

No ID Information.


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