Provider Demographics
NPI:1518349810
Name:REFAHI, POOYAN (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:POOYAN
Middle Name:
Last Name:REFAHI
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 OLD COLONY AVE UNIT 7
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2450
Mailing Address - Country:US
Mailing Address - Phone:978-686-8500
Mailing Address - Fax:
Practice Address - Street 1:115 NORWOOD PARK S STE 200
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4633
Practice Address - Country:US
Practice Address - Phone:781-762-9332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18570151223P0300X
MA390200000X
VA04014160381223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program