Provider Demographics
NPI:1043447212
Name:MAREFAT, MAHPAREH (DMD, DMSC)
Entity Type:Individual
Prefix:
First Name:MAHPAREH
Middle Name:
Last Name:MAREFAT
Suffix:
Gender:F
Credentials:DMD, DMSC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:MAREFAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, DMSC
Mailing Address - Street 1:2400 COMPUTER DR.
Mailing Address - Street 2:ORAL HEALTH CENTER
Mailing Address - City:WEST BOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581
Mailing Address - Country:US
Mailing Address - Phone:508-329-2302
Mailing Address - Fax:508-329-2255
Practice Address - Street 1:2400 COMPUTER DR.
Practice Address - Street 2:ORAL HEALTH CENTER
Practice Address - City:WEST BOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-329-2302
Practice Address - Fax:508-329-2255
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA#147351223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics