Provider Demographics
NPI:1427118934
Name:MOBASHERAT, MOHAMMED E (DMD MSCD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:E
Last Name:MOBASHERAT
Suffix:
Gender:M
Credentials:DMD MSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3850 MYSTIC VALLEY PKWY
Mailing Address - Street 2:MEADOW GLEN MALL
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155
Mailing Address - Country:US
Mailing Address - Phone:781-396-6613
Mailing Address - Fax:781-395-4292
Practice Address - Street 1:3850 MYSTIC VALLEY PKWY
Practice Address - Street 2:MEADOW GLEN MALL
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155
Practice Address - Country:US
Practice Address - Phone:781-396-6613
Practice Address - Fax:781-395-4292
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA153761223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9770658Medicaid