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General NPI Number Information
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NPI Number | 1306155411
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Entity Type | Individual
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Provider Name | AHMADREZA ARASH RAJAEI DMD
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Gender | Male
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Dates
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Enumeration Date | 10/07/2010
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 100 E NEWTON ST SUITE 104B
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City | BOSTON
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State | MA
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Zip | 02118
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Country | US
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Telephone | 617-638-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 30 GARRISON ST #409
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City | BOSTON
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State | MA
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Zip | 02116-5741
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Country | US
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Telephone | 617-893-3443
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DL11022
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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 | DN1855921
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License Number State | MA
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