Provider Demographics
NPI:1639527690
Name:BEHAZIN, NIMA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NIMA
Middle Name:
Last Name:BEHAZIN
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 1:4959 TOWER HILL RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-2283
Mailing Address - Country:US
Mailing Address - Phone:401-783-1975
Mailing Address - Fax:
Practice Address - Street 1:4959 TOWER HILL RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-2283
Practice Address - Country:US
Practice Address - Phone:401-783-1975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN034521223G0001X
CT118141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice