Provider Demographics
NPI:1164707808
Name:GHAFFARIGARAKANI, SASAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SASAN
Middle Name:
Last Name:GHAFFARIGARAKANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BROOKLINE AVE
Mailing Address - Street 2:APT 21A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5408
Mailing Address - Country:US
Mailing Address - Phone:310-926-3229
Mailing Address - Fax:
Practice Address - Street 1:2800 COORS BLVD NW STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1204
Practice Address - Country:US
Practice Address - Phone:310-926-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60878122300000X, 1223G0001X
CT110881223G0001X
NMDD4634122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice