Provider Demographics
NPI:1730106469
Name:RAEISIAN, NINA N (DMD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:N
Last Name:RAEISIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:NAZANIN
Other - Middle Name:N
Other - Last Name:RAEISIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:46-48 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757
Mailing Address - Country:US
Mailing Address - Phone:508-482-0028
Mailing Address - Fax:508-482-9585
Practice Address - Street 1:46-48 MAIN ST
Practice Address - Street 2:MILFORD DENTAL GROUP
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:508-482-0028
Practice Address - Fax:508-482-9585
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice