Provider Demographics
NPI:1740390541
Name:POURATI, JACOB ARASH (DMD, MSD, CAGS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ARASH
Last Name:POURATI
Suffix:
Gender:M
Credentials:DMD, MSD, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LONGWOOD AVE APT 820
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5224
Mailing Address - Country:US
Mailing Address - Phone:617-240-9158
Mailing Address - Fax:
Practice Address - Street 1:57 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4027
Practice Address - Country:US
Practice Address - Phone:617-484-2431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204691223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics