Healthcare Provider Details

I. General information

NPI: 1841429776
Provider Name (Legal Business Name): HAMED VAZIRI ORTHODONTICS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 FARMINGTON AVE UNIT 206
WEST HARTFORD CT
06119-1743
US

IV. Provider business mailing address

730 FARMINGTON AVE UNIT 206
WEST HARTFORD CT
06119-1743
US

V. Phone/Fax

Practice location:
  • Phone: 774-280-2543
  • Fax:
Mailing address:
  • Phone: 774-280-2543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number28988
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number010740
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: