Provider Demographics
NPI:1619783693
Name:SAHAR MOSTAFAVI DMD PC
Entity type:Organization
Organization Name:SAHAR MOSTAFAVI DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSTAFAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-935-1018
Mailing Address - Street 1:374 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1818
Mailing Address - Country:US
Mailing Address - Phone:781-784-7391
Mailing Address - Fax:
Practice Address - Street 1:374 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1818
Practice Address - Country:US
Practice Address - Phone:781-784-7391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty