Provider Demographics
NPI:1477045334
Name:MOHAMMADI, SASHA (DDS, MS)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:MOHAMMADI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 W 191ST ST
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085-8889
Mailing Address - Country:US
Mailing Address - Phone:913-220-7495
Mailing Address - Fax:
Practice Address - Street 1:35 BEDFORD ST STE 20
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4440
Practice Address - Country:US
Practice Address - Phone:781-590-6703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2025-07-28
Deactivation Date:2023-08-02
Deactivation Code:
Reactivation Date:2023-08-15
Provider Licenses
StateLicense IDTaxonomies
NH052531223P0300X
VA04014186261223P0300X
PADS0444611223P0300X
MADN100010401223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics