MEDICARE: AFSANEH SAMADANI D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	20506	MA

General Provider Information

NPI Number	:	1205059623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AFSANEH SAMADANI D.M.D.

Provider Business Mailing Address
First Line	:	1753 MASSACHUSETTS AVE
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02140-2231
Country	:	US
Telephone Number	:	617-491-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1753 MASSACHUSETTS AVE
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02140-2231
Country	:	US
Telephone Number	:	617-491-6800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	04/09/2025

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