Healthcare Provider Details

I. General information

NPI: 1467479105
Provider Name (Legal Business Name): ROXANA NAMDARI ZANDI D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ROBERT TONER BLVD.
ATTLEBORO FALLS MA
02763
US

IV. Provider business mailing address

10 ROBERT TONER BLVD.
ATTLEBORO FALLS MA
02763
US

V. Phone/Fax

Practice location:
  • Phone: 508-699-2299
  • Fax: 508-699-2213
Mailing address:
  • Phone: 508-699-2299
  • Fax: 508-699-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19002
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: