Healthcare Provider Details

I. General information

NPI: 1992911820
Provider Name (Legal Business Name): NILOUFAR KHOOBEHI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WHITING ST SUITE 2
HINGHAM MA
02043-3724
US

IV. Provider business mailing address

210 WHITING ST SUITE 2
HINGHAM MA
02043-3724
US

V. Phone/Fax

Practice location:
  • Phone: 781-749-1119
  • Fax:
Mailing address:
  • Phone: 781-749-1119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number20280
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: