=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700432143
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIDDLEBORO ORAL SURGEONS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2019
-----------------------------------------------------
Last Update Date | 08/12/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 47 BEDFORD ST UNIT 3
-----------------------------------------------------
City | MIDDLEBORO
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02346-1047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-947-8452
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 47 BEDFORD ST UNIT 3
-----------------------------------------------------
City | MIDDLEBORO
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02346-1047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-947-8452
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/SURGEON
-----------------------------------------------------
Name | DR. ALIREZA ASHRAFI
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 617-838-7100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------