Provider Demographics
NPI:1114011475
Name:GOLPARVAR, MOHAMMAD H (DMD)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:H
Last Name:GOLPARVAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 APPLE RDG
Mailing Address - Street 2:UNIT # 2
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754-2716
Mailing Address - Country:US
Mailing Address - Phone:978-461-0599
Mailing Address - Fax:
Practice Address - Street 1:184 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-2932
Practice Address - Country:US
Practice Address - Phone:781-221-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice