Provider Demographics
NPI:1669687166
Name:BURLINGTON CHILDRENS DENTAL
Entity Type:Organization
Organization Name:BURLINGTON CHILDRENS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MORTEZA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-229-2220
Mailing Address - Street 1:30 CHESNUT AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-1607
Mailing Address - Country:US
Mailing Address - Phone:781-229-2220
Mailing Address - Fax:781-229-0258
Practice Address - Street 1:131 CAMBRIDGE ST STE 1
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3711
Practice Address - Country:US
Practice Address - Phone:781-229-2220
Practice Address - Fax:781-229-0258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0297828OtherMASS HEALTH
MA110011979BMedicaid