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General NPI Number Information
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NPI Number | 1972286177
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Entity Type | Individual
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Provider Name | SEPEHR MAGHSOUDLOO DMD
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Gender | Male
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 635 ALBANY ST
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City | BOSTON
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State | MA
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Zip | 02118-3550
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Country | US
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Telephone | 617-358-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 3920 MYSTIC VALLEY PKWY APT 1002
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City | MEDFORD
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State | MA
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Zip | 02155-6910
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Country | US
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Telephone | 781-475-4821
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1860011
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License Number State | MA
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