Provider Demographics
NPI:1215181474
Name:KAMALI, NASSER
Entity Type:Individual
Prefix:
First Name:NASSER
Middle Name:
Last Name:KAMALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1314
Mailing Address - Country:US
Mailing Address - Phone:781-581-9832
Mailing Address - Fax:781-581-9583
Practice Address - Street 1:232 UNION ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1315
Practice Address - Country:US
Practice Address - Phone:781-581-9832
Practice Address - Fax:781-581-9583
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice