Provider Demographics
NPI:1205023975
Name:HANCOCK DENTAL PC
Entity Type:Organization
Organization Name:HANCOCK DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGHAYEGH-ASKARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-773-6605
Mailing Address - Street 1:522 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:WOLLASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02170-1921
Mailing Address - Country:US
Mailing Address - Phone:617-773-6605
Mailing Address - Fax:617-773-6606
Practice Address - Street 1:522 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:WOLLASTON
Practice Address - State:MA
Practice Address - Zip Code:02170-1921
Practice Address - Country:US
Practice Address - Phone:617-773-6605
Practice Address - Fax:617-773-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty