Provider Demographics
NPI:1619383247
Name:GHASSEM-ZADEH, SEAN AMIR (DMD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:AMIR
Last Name:GHASSEM-ZADEH
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 1:205 RICHDALE AVE APT A11
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-3339
Mailing Address - Country:US
Mailing Address - Phone:203-954-7543
Mailing Address - Fax:
Practice Address - Street 1:1180 BEACON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1103
Practice Address - Country:US
Practice Address - Phone:203-954-7543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT114871223P0221X
MADN18571601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry