Provider Demographics
NPI:1477563682
Name:YAZDI, MORTEZA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:MORTEZA
Middle Name:A
Last Name:YAZDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 CAMBRIDGE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-3711
Mailing Address - Country:US
Mailing Address - Phone:781-229-2220
Mailing Address - Fax:781-229-0258
Practice Address - Street 1:131 CAMBRIDGE ST STE 1
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3711
Practice Address - Country:US
Practice Address - Phone:781-229-2220
Practice Address - Fax:781-229-0258
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA199401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110011979BMedicaid
MA0297828OtherMASS HEALTH