Provider Demographics
NPI:1740403906
Name:AMIR SHAHBAZIAN, DMD PC
Entity Type:Organization
Organization Name:AMIR SHAHBAZIAN, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHBAZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD PC
Authorized Official - Phone:617-479-7625
Mailing Address - Street 1:157 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5514
Mailing Address - Country:US
Mailing Address - Phone:617-479-7625
Mailing Address - Fax:617-479-7610
Practice Address - Street 1:157 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5514
Practice Address - Country:US
Practice Address - Phone:617-479-7625
Practice Address - Fax:617-479-7610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17290122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1578685236OtherDENTIST
MA1134262587OtherDENTIST