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General NPI Number Information
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NPI Number | 1538623111
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Entity Type | Organization
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Legal Business Name | NIMA ANSARI DMD PLLC (DBA: OUR FAMILY DENTAL)
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Dates
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Enumeration Date | 01/28/2019
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Last Update Date | 01/29/2019
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Provider Practice Location Address
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Address Line | 700 SOUTHBRIDGE ST STE 2
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City | WORCESTER
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State | MA
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Zip | 01610-2941
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Country | US
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Telephone | 774-243-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 87 GAINSBOROUGH ST APT 408
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City | BOSTON
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State | MA
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Zip | 02115-6537
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Country | US
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Telephone | 917-364-1080
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. NIMA ANSARI
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Credential | DMD
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Telephone | 917-364-1080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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