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General NPI Number Information
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NPI Number | 1912027293
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Entity Type | Individual
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Provider Name | FARDAD MOBED D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 603 BROADWAY
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City | REVERE
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State | MA
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Zip | 02151-3045
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Country | US
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Telephone | 781-289-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 14 WEBB AVE
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City | WELLESLEY
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State | MA
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Zip | 02481-5431
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Country | US
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Telephone | 781-289-3600
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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 | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 18187
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 18187
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 18187
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License Number State | MA
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