Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 17281 | MA |
NPI | 1053628032 |
---|---|
Provider Name | Mohammad Hossein Dashti |
First Address | Somerville, MA 02143-3823 |
Second Address | Somerville, MA 02143-3823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2010 |
Last Update Date | 11/09/2010 |