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General NPI Number Information
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NPI Number | 1336282300
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Entity Type | Organization
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Legal Business Name | WAVERLEY OAKS DENTAL CARE SPECIALISTS LLC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 411 WAVERLEY OAKS RD BLDG #3, STE. 318
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City | WALTHAM
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State | MA
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Zip | 02452-8448
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Country | US
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Telephone | 781-647-0022
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Fax | 781-647-1122
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Provider Business Mailing Address
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Address Line | 411 WAVERLEY OAKS RD BLDG #3, STE. 318
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City | WALTHAM
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State | MA
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Zip | 02452-8448
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Country | US
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Telephone | 781-647-0022
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Fax | 781-647-1122
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAHIN SOLI SAGAFI
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Credential | DMD
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Telephone | 781-647-0022
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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 | 18464
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License Number State | MA
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