Provider Demographics
NPI:1710501929
Name:ROSTAMNEZHAD, YALDA (DMD)
Entity Type:Individual
Prefix:
First Name:YALDA
Middle Name:
Last Name:ROSTAMNEZHAD
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 1:493 GAY ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-1729
Mailing Address - Country:US
Mailing Address - Phone:781-801-7673
Mailing Address - Fax:
Practice Address - Street 1:493 GAY ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-1729
Practice Address - Country:US
Practice Address - Phone:781-801-7673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18586471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice