Healthcare Provider Details

I. General information

NPI: 1952456196
Provider Name (Legal Business Name): MOJGAN RAHIMI D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 BOSTON POST RD E
MARLBOROUGH MA
01752-3645
US

IV. Provider business mailing address

80 DOUBLET HILL RD
WESTON MA
02493-2331
US

V. Phone/Fax

Practice location:
  • Phone: 508-481-8094
  • Fax:
Mailing address:
  • Phone: 781-647-1366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19617
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number19617
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: