Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | LD00141 | RI |
Y | 1223X0400X | Orthodontists | DN1858940 | MA |
NPI | 1093235590 |
---|---|
Provider Name | Dr. Sahar Mostafavi |
First Address | Newton, MA 02459-1747 |
Second Address | Westborough, MA 01581-2655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2017 |
Last Update Date | 06/07/2021 |