Provider Demographics
NPI:1093235590
Name:MOSTAFAVI, SAHAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAHAR
Middle Name:
Last Name:MOSTAFAVI
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 1:58 BRENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1747
Mailing Address - Country:US
Mailing Address - Phone:617-935-1018
Mailing Address - Fax:
Practice Address - Street 1:1 OAK ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-2655
Practice Address - Country:US
Practice Address - Phone:508-986-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILD001411223D0001X
MADN18589401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223D0001XDental ProvidersDentistDental Public Health