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General NPI Number Information
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NPI Number | 1417631441
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Entity Type | Individual
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Provider Name | SAHAR MOHEBBI-POUR
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Gender | Female
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 1120 BOSTON TPKE
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City | BOLTON
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State | CT
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Zip | 06043-7439
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Country | US
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Telephone | 860-646-3003
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Fax |
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Provider Business Mailing Address
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Address Line | 39 EDEN AVE UNIT 8
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City | SOUTHINGTON
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State | CT
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Zip | 06489-4551
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Country | US
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Telephone | 202-344-0390
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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 | 28044
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License Number State | FL
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