Provider Demographics
NPI:1194597245
Name:MEHDI RAHMATPOUR DMD LLC
Entity type:Organization
Organization Name:MEHDI RAHMATPOUR DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMATPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-567-8882
Mailing Address - Street 1:199 SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-3258
Mailing Address - Country:US
Mailing Address - Phone:781-629-6613
Mailing Address - Fax:617-997-4737
Practice Address - Street 1:199 SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3258
Practice Address - Country:US
Practice Address - Phone:781-629-6613
Practice Address - Fax:617-997-4737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty