Provider Demographics
NPI:1497196570
Name:AMELI, TOURADJ MOSTAFA (DMD)
Entity Type:Individual
Prefix:DR
First Name:TOURADJ
Middle Name:MOSTAFA
Last Name:AMELI
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 1:180 LINDEN ST
Mailing Address - Street 2:3RD FLOOR SUITE 8C
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7924
Mailing Address - Country:US
Mailing Address - Phone:781-237-1190
Mailing Address - Fax:
Practice Address - Street 1:180 LINDEN ST
Practice Address - Street 2:3TH FLOOR SUITE 8C
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7924
Practice Address - Country:US
Practice Address - Phone:781-237-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2014-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN187251223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics