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General NPI Number Information
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NPI Number | 1194129437
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Entity Type | Individual
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Provider Name | NOOSHA KHADIVI DMD
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Gender | Female
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 50 THOMPSON RD
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City | WEBSTER
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State | MA
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Zip | 01570-1408
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Country | US
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Telephone | 508-943-8111
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Fax |
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Provider Business Mailing Address
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Address Line | 15 MORGAN DR UNIT 301
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City | NATICK
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State | MA
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Zip | 01760-4296
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Country | US
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Telephone | 781-243-1028
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1856745
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License Number State | MA
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