Provider Demographics
NPI:1205547858
Name:RABIEI, AZIM
Entity type:Individual
Prefix:DR
First Name:AZIM
Middle Name:
Last Name:RABIEI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SAINT PAUL ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6546
Mailing Address - Country:US
Mailing Address - Phone:813-765-3161
Mailing Address - Fax:
Practice Address - Street 1:245 1ST ST STE 17
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1292
Practice Address - Country:US
Practice Address - Phone:617-892-8325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL154691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice