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General NPI Number Information
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NPI Number | 1235280652
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Entity Type | Individual
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Provider Name | LEILA NEZAKATGOO D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/13/2007
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 234 WASHINGTON ST
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City | HUDSON
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State | MA
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Zip | 01749-3735
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Country | US
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Telephone | 978-562-3330
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Fax | 978-922-0037
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Provider Business Mailing Address
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Address Line | 183 OAK ST APT 201C
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City | NEWTON UPPER FALLS
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State | MA
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Zip | 02464-1452
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Country | US
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Telephone | 202-277-6730
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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 | DN1858102
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 13622
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License Number State | MD
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