Healthcare Provider Details

I. General information

NPI: 1619783693
Provider Name (Legal Business Name): SAHAR MOSTAFAVI DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 S MAIN ST
SHARON MA
02067-1818
US

IV. Provider business mailing address

374 S MAIN ST
SHARON MA
02067-1818
US

V. Phone/Fax

Practice location:
  • Phone: 781-784-7391
  • Fax:
Mailing address:
  • Phone: 781-784-7391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SAHAR MOSTAFAVI
Title or Position: OWNER
Credential: DMD
Phone: 617-935-1018