Provider Demographics
NPI:1710462007
Name:BAKERYWALA, ARIFA MOHAMMED IQBAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ARIFA
Middle Name:MOHAMMED IQBAL
Last Name:BAKERYWALA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SAINT ALPHONSUS ST APT 1806
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-1690
Mailing Address - Country:US
Mailing Address - Phone:914-374-4103
Mailing Address - Fax:
Practice Address - Street 1:3033 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02119-1227
Practice Address - Country:US
Practice Address - Phone:617-541-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18581731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice