Provider Demographics
NPI:1477609923
Name:MAHOOZI, AMIR MOHSEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:MOHSEN
Last Name:MAHOOZI
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 1:15 VALENTINE ST APT 10
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4042
Mailing Address - Country:US
Mailing Address - Phone:617-970-3682
Mailing Address - Fax:
Practice Address - Street 1:402 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-3823
Practice Address - Country:US
Practice Address - Phone:617-666-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193121223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics