Provider Demographics
NPI:1629754346
Name:BEHZADI, FERNANDA (DDS)
Entity type:Individual
Prefix:
First Name:FERNANDA
Middle Name:
Last Name:BEHZADI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 E DEDHAM ST APT 205
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-5010
Mailing Address - Country:US
Mailing Address - Phone:561-542-9946
Mailing Address - Fax:
Practice Address - Street 1:364 HARVARD ST # 1C
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2920
Practice Address - Country:US
Practice Address - Phone:617-232-6188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN10000233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist