Provider Demographics
NPI:1851349708
Name:MAHDAVI, PEIMAN (DMD)
Entity Type:Individual
Prefix:
First Name:PEIMAN
Middle Name:
Last Name:MAHDAVI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 MAIN ST.
Mailing Address - Street 2:SUITE#1
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081
Mailing Address - Country:US
Mailing Address - Phone:508-668-8008
Mailing Address - Fax:508-668-8808
Practice Address - Street 1:1428 MAIN ST
Practice Address - Street 2:SUITE#1
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1729
Practice Address - Country:US
Practice Address - Phone:508-668-8008
Practice Address - Fax:508-668-8808
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA179651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics