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General NPI Number Information
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NPI Number | 1275733263
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Entity Type | Organization
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Legal Business Name | MARIAM GHAVAMIAN DMD PC
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 21 LONGWOOD AVE
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City | BROOKLINE
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State | MA
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Zip | 02446
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Country | US
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Telephone | 617-738-0806
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Fax |
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Provider Business Mailing Address
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Address Line | 21 LONGWOOD AVE
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City | BROOKLINE
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State | MA
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Zip | 02446
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Country | US
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Telephone | 617-738-0806
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIAM GHAVAMIAN
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Credential | DMD
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Telephone | 617-738-0806
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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 | 18012
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License Number State | MA
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