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General NPI Number Information
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NPI Number | 1225233778
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Entity Type | Individual
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Provider Name | ROSHANAK GHAZINOURI D.M.D
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Gender | Female
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1037 BEACON ST SUITE 2A
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City | BROOKLINE
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State | MA
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Zip | 02446-5656
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Country | US
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Telephone | 617-738-7210
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Fax |
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Provider Business Mailing Address
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Address Line | 14 WRIGHT ST
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City | CAMBRIDGE
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State | MA
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Zip | 02138-1704
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Country | US
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Telephone | 617-256-6259
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 17415
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License Number State | MA
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