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General NPI Number Information
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NPI Number | 1215574694
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Entity Type | Organization
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Legal Business Name | NISTAR PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 12/05/2019
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Last Update Date | 12/05/2019
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Provider Practice Location Address
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Address Line | 76 MERRIMACK ST STE 8A
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City | HAVERHILL
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State | MA
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Zip | 01830-6246
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Country | US
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Telephone | 917-892-3625
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Fax |
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Provider Business Mailing Address
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Address Line | 45 OWENCROFT RD
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City | BOSTON
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State | MA
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Zip | 02124-4723
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Country | US
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Telephone | 917-892-3625
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | SHAHNAAZ NISTAR
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Credential | DDS
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Telephone | 917-892-3625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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