Healthcare Provider Details

I. General information

NPI: 1518261718
Provider Name (Legal Business Name): NEDA HOVAIZI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 SEA STREET
QUINCY MA
02169-2742
US

IV. Provider business mailing address

495 SEA STREET
QUINCY MA
02169-2742
US

V. Phone/Fax

Practice location:
  • Phone: 617-847-1400
  • Fax: 617-847-1500
Mailing address:
  • Phone: 617-847-1400
  • Fax: 617-847-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1855605
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: