Healthcare Provider Details

I. General information

NPI: 1972100964
Provider Name (Legal Business Name): DAFJOLA BEJLERAJ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2020
Last Update Date: 09/08/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HIGH ST STE 333
BOSTON MA
02110-1672
US

IV. Provider business mailing address

10 HIGH ST STE 333
BOSTON MA
02110-1672
US

V. Phone/Fax

Practice location:
  • Phone: 617-482-2500
  • Fax: 875-991-1761
Mailing address:
  • Phone: 617-482-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1858839
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1858839
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7452
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: