Healthcare Provider Details

I. General information

NPI: 1699502880
Provider Name (Legal Business Name): OCEANVIEW DENTAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 ROGERS ST STE 3-2
GLOUCESTER MA
01930-5038
US

IV. Provider business mailing address

17 ROGERS ST STE 3-2
GLOUCESTER MA
01930-5038
US

V. Phone/Fax

Practice location:
  • Phone: 978-283-6252
  • Fax: 978-283-1722
Mailing address:
  • Phone: 978-283-6252
  • Fax: 978-283-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. MAHSHID MIRGHASSEMI
Title or Position: OWNER
Credential: DDS
Phone: 978-283-6252