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General NPI Number Information
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NPI Number | 1881435352
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Entity Type | Individual
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Provider Name | NINA RAZAVI DMD
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Gender | Female
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 481 OLD POST RD UNIT A
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City | NORTH ATTLEBORO
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State | MA
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Zip | 02760-4244
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Country | US
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Telephone | 508-695-7031
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Fax |
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Provider Business Mailing Address
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Address Line | 85 SEAPORT BLVD UNIT 1416
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City | BOSTON
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State | MA
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Zip | 02210-2167
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Country | US
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Telephone | 813-777-2972
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DEN100526
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License Number State | MA
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