Healthcare Provider Details

I. General information

NPI: 1497583157
Provider Name (Legal Business Name): MAJID HEIDARPOUR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S MAIN ST
CONCORD NH
03301-3483
US

IV. Provider business mailing address

410 S MAIN ST
CONCORD NH
03301-3483
US

V. Phone/Fax

Practice location:
  • Phone: 603-609-7467
  • Fax:
Mailing address:
  • Phone: 603-609-7467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDL16004
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number05234
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: