Healthcare Provider Details

I. General information

NPI: 1124941661
Provider Name (Legal Business Name): JAYDEN SARA ROUHI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 WASHINGTON ST
DORCHESTER MA
02124-3510
US

IV. Provider business mailing address

770 BOYLSTON ST APT 5E
BOSTON MA
02199-7704
US

V. Phone/Fax

Practice location:
  • Phone: 617-825-9660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL101640
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: