Provider Demographics
NPI:1972735793
Name:EAST BOSTON FAMILY DENTAL CENTER
Entity type:Organization
Organization Name:EAST BOSTON FAMILY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMATPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-567-8882
Mailing Address - Street 1:79 MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1959
Mailing Address - Country:US
Mailing Address - Phone:617-567-8882
Mailing Address - Fax:617-997-4737
Practice Address - Street 1:79 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1959
Practice Address - Country:US
Practice Address - Phone:617-567-8882
Practice Address - Fax:617-997-4737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA197571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty