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General NPI Number Information
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NPI Number | 1720128325
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Entity Type | Organization
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Legal Business Name | LUX DENTAL
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 505 WASHINGTON ST
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City | QUINCY
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State | MA
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Zip | 02169-5834
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Country | US
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Telephone | 617-639-5942
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Fax |
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Provider Business Mailing Address
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Address Line | 505 WASHINGTON ST
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City | QUINCY
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State | MA
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Zip | 02169-5834
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Country | US
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Telephone | 617-639-5942
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST AND PARTIAL OWNER
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Name | DR. SAEED KASHEFI
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Credential | DMD
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Telephone | 617-639-5942
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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 | 21249
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License Number State | MA
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