Provider Demographics
NPI:1902825144
Name:TEHRANI, ABOL MASSIH (DDS DMD CAGS)
Entity Type:Individual
Prefix:DR
First Name:ABOL
Middle Name:MASSIH
Last Name:TEHRANI
Suffix:
Gender:M
Credentials:DDS DMD CAGS
Other - Prefix:DR
Other - First Name:ABOLGHASSEM
Other - Middle Name:MASSIH
Other - Last Name:TEHRANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS DMD CAGS
Mailing Address - Street 1:121 MERRIMACK STREET
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6107
Mailing Address - Country:US
Mailing Address - Phone:978-372-5011
Mailing Address - Fax:978-372-5011
Practice Address - Street 1:121 MERRIMACK STREET
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6107
Practice Address - Country:US
Practice Address - Phone:978-372-5011
Practice Address - Fax:978-372-5011
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice