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General NPI Number Information
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NPI Number | 1740638667
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Entity Type | Organization
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Legal Business Name | MODERN DENTISTRY LLC
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Dates
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Enumeration Date | 06/01/2016
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Last Update Date | 06/01/2016
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Provider Practice Location Address
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Address Line | 307 GRAFTON ST 202-203
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City | SHREWSBURY
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State | MA
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Zip | 01545-6236
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Country | US
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Telephone | 508-842-8838
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Fax | 508-842-6356
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Provider Business Mailing Address
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Address Line | 307 GRAFTON ST 202-203
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City | SHREWSBURY
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State | MA
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Zip | 01545-6236
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Country | US
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Telephone | 508-842-8838
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Fax | 508-842-6356
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MEHDI KARIMIPOUR
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Credential | DMD
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Telephone | 617-935-7536
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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 | DN1856214
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License Number State | MA
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