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General NPI Number Information
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NPI Number | 1790668770
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Entity Type | Organization
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Legal Business Name | MAZDENTA ADVANCED DENTISTRY PLLC
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Dates
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Enumeration Date | 07/28/2025
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 1 TROWBRIDGE RD STE 7
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City | BOURNE
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State | MA
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Zip | 02532-3662
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Country | US
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Telephone | 508-759-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 12 JEREMIAH CIR
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City | MEDFORD
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State | MA
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Zip | 02155-1676
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Country | US
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Telephone | 857-250-1515
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Fax |
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Authorized Official
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Title or Position | DMD
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Name | KHOSROW DINYARYAN
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Credential |
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Telephone | 857-250-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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