Provider Demographics
NPI:1619123155
Name:GHASSEMI, SARA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:GHASSEMI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:GHASSEMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1765 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1535
Mailing Address - Country:US
Mailing Address - Phone:617-327-4321
Mailing Address - Fax:
Practice Address - Street 1:1765 CENTRE ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1535
Practice Address - Country:US
Practice Address - Phone:617-327-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN215341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics