Provider Demographics
NPI:1376900050
Name:AMIR MOHSEN MAHOOZI DMD, PC
Entity Type:Organization
Organization Name:AMIR MOHSEN MAHOOZI DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:MOHSEN
Authorized Official - Last Name:MAHOOZI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, CAGS
Authorized Official - Phone:617-970-3682
Mailing Address - Street 1:388 COMMONWEALTH AVE
Mailing Address - Street 2:UNIT B-1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2800
Mailing Address - Country:US
Mailing Address - Phone:617-859-8000
Mailing Address - Fax:671-859-8001
Practice Address - Street 1:388 COMMONWEALTH AVE
Practice Address - Street 2:UNIT B-1
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2800
Practice Address - Country:US
Practice Address - Phone:617-859-8000
Practice Address - Fax:671-859-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN19312302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization