Basic Information
| Provider Information | |||||||||
| NPI: | 1043709280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOUNSALIEH | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450B PARADISE RD # 318 | ||||||||
| Address2: | |||||||||
| City: | SWAMPSCOTT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019071300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177590178 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 228 WASHINGTON ST STE A-140 | ||||||||
| Address2: | |||||||||
| City: | ATTLEBORO | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027035561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7742065592 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2018 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | DN1859172 | MA | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.