Healthcare Provider Details

I. General information

NPI: 1962469908
Provider Name (Legal Business Name): NADER VAKILI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 CONCORD ST
FRAMINGHAM MA
01702-8302
US

IV. Provider business mailing address

32 CONCORD ST
FRAMINGHAM MA
01702-8302
US

V. Phone/Fax

Practice location:
  • Phone: 508-270-2787
  • Fax:
Mailing address:
  • Phone: 508-270-2787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number049163-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number21319
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN21319
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: