Provider Demographics
NPI:1184199457
Name:ALIZADEH CHAFJIRI, PADIDEH MOHAMMAD
Entity Type:Individual
Prefix:
First Name:PADIDEH
Middle Name:MOHAMMAD
Last Name:ALIZADEH CHAFJIRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 BAYLSTON STREET APT 801
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116
Mailing Address - Country:US
Mailing Address - Phone:646-895-1312
Mailing Address - Fax:
Practice Address - Street 1:62 BAYLSTON STREET APT 801
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116
Practice Address - Country:US
Practice Address - Phone:646-895-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18581361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice