Healthcare Provider Details

I. General information

NPI: 1326223736
Provider Name (Legal Business Name): SETAREH RAZZAGHI DDS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 WASHINGTON AVENUE
PORTLAND ME
04103
US

IV. Provider business mailing address

1321 WASHINGTON AVENUE
PORTLAND ME
04103
US

V. Phone/Fax

Practice location:
  • Phone: 207-797-5577
  • Fax: 207-797-0072
Mailing address:
  • Phone: 207-797-5577
  • Fax: 207-797-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4041
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: