Provider Demographics
NPI:1699982645
Name:ZHALEH J. HAMI,DMD&BAHRAM GHASSEMI TARY,D.M.D.,P.C.
Entity type:Organization
Organization Name:ZHALEH J. HAMI,DMD&BAHRAM GHASSEMI TARY,D.M.D.,P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZHALEH
Authorized Official - Middle Name:JOLLE
Authorized Official - Last Name:HAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-327-4321
Mailing Address - Street 1:1765 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1535
Mailing Address - Country:US
Mailing Address - Phone:617-327-4321
Mailing Address - Fax:617-325-1720
Practice Address - Street 1:1765 CENTRE ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1535
Practice Address - Country:US
Practice Address - Phone:617-327-4321
Practice Address - Fax:617-325-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0271462Medicaid