Provider Demographics
NPI:1881028975
Name:NAVID, SHAHRAM
Entity Type:Individual
Prefix:
First Name:SHAHRAM
Middle Name:
Last Name:NAVID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1647
Mailing Address - Country:US
Mailing Address - Phone:978-532-5550
Mailing Address - Fax:978-532-8078
Practice Address - Street 1:210 ANDOVER ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1647
Practice Address - Country:US
Practice Address - Phone:978-532-5550
Practice Address - Fax:978-532-8078
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist