Provider Demographics
NPI:1336282300
Name:WAVERLEY OAKS DENTAL CARE SPECIALISTS LLC
Entity Type:Organization
Organization Name:WAVERLEY OAKS DENTAL CARE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHIN
Authorized Official - Middle Name:SOLI
Authorized Official - Last Name:SAGAFI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-647-0022
Mailing Address - Street 1:411 WAVERLEY OAKS RD
Mailing Address - Street 2:BLDG #3, STE. 318
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-8448
Mailing Address - Country:US
Mailing Address - Phone:781-647-0022
Mailing Address - Fax:781-647-1122
Practice Address - Street 1:411 WAVERLEY OAKS RD
Practice Address - Street 2:BLDG #3, STE. 318
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8448
Practice Address - Country:US
Practice Address - Phone:781-647-0022
Practice Address - Fax:781-647-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA184641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX12212OtherBLUE CROSS BLUE SHIELDS