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General NPI Number Information
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NPI Number | 1699263541
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Entity Type | Individual
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Provider Name | POUYA AMIRI-HEZAVEH DMD
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Gender | Male
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 06/09/2020
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Provider Practice Location Address
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Address Line | 530 BOSTON POST RD E
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City | MARLBOROUGH
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State | MA
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Zip | 01752-3645
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Country | US
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Telephone | 585-481-8094
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Fax |
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Provider Business Mailing Address
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Address Line | 60 HOPE AVE APT 515
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City | WALTHAM
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State | MA
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Zip | 02453-4701
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Country | US
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Telephone | 781-820-2173
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1858463
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License Number State | MA
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