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General NPI Number Information
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NPI Number | 1548830672
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Entity Type | Individual
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Provider Name | LILY RAZAVI DMD
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Gender | Female
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Dates
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Enumeration Date | 06/30/2021
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 1 KNEELAND ST
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City | BOSTON
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State | MA
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Zip | 02111-1527
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Country | US
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Telephone | 617-636-6828
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Fax |
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Provider Business Mailing Address
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Address Line | 55 TRAVELER ST APT 1001
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City | BOSTON
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State | MA
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Zip | 02118-2969
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Country | US
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Telephone | 703-349-9831
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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 | DN1859018
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License Number State | MA
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