Healthcare Provider Details

I. General information

NPI: 1780657494
Provider Name (Legal Business Name): REZA RAHBAR DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2006
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LONGWOOD AVE FLOOR 3
BOSTON MA
02115-5711
US

IV. Provider business mailing address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6417
  • Fax:
Mailing address:
  • Phone: 617-355-3795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number80628
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number17270
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: