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General NPI Number Information
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NPI Number | 1770824575
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Entity Type | Organization
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Legal Business Name | ALIAKBAR ESMAEILI DDS LLC
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 4238 WASHINGTON ST UNIT C
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City | ROSLINDALE
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State | MA
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Zip | 02131-2517
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Country | US
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Telephone | 917-767-3860
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Fax |
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Provider Business Mailing Address
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Address Line | 49 BROOK RD
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City | WESTON
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State | MA
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Zip | 02493-1766
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Country | US
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Telephone | 781-609-2082
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. ALIAKBAR ESMAEILI
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Credential | DDS
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Telephone | 917-767-3860
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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 | DN1855096
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License Number State | MA
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