Provider Demographics
NPI:1235492521
Name:GHAFFARI, ROUDABEH K (DMD)
Entity Type:Individual
Prefix:
First Name:ROUDABEH
Middle Name:K
Last Name:GHAFFARI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:RUBY
Other - Middle Name:
Other - Last Name:GHAFFARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:22 WARBLER SPRINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773
Mailing Address - Country:US
Mailing Address - Phone:781-259-3141
Mailing Address - Fax:
Practice Address - Street 1:396 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2512
Practice Address - Country:US
Practice Address - Phone:617-776-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18195122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist