Provider Demographics
NPI:1316159312
Name:NASSERIPOUR, NEGAR MELANIE (DMD)
Entity type:Individual
Prefix:DR
First Name:NEGAR
Middle Name:MELANIE
Last Name:NASSERIPOUR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 EXETER ST APT 908
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2843
Mailing Address - Country:US
Mailing Address - Phone:617-304-8700
Mailing Address - Fax:
Practice Address - Street 1:551 BOYLSTON ST STE 501
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3605
Practice Address - Country:US
Practice Address - Phone:617-536-4020
Practice Address - Fax:617-424-1004
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist