Provider Demographics
NPI:1922163567
Name:RAMESH IZEDIAN DMD, SHAHRAM MOGHADDAM DMD, PAUL DOBRIN DMD, PC
Entity Type:Organization
Organization Name:RAMESH IZEDIAN DMD, SHAHRAM MOGHADDAM DMD, PAUL DOBRIN DMD, PC
Other - Org Name:DENTAL ARTS ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOBRIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-776-2323
Mailing Address - Street 1:396 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144
Mailing Address - Country:US
Mailing Address - Phone:617-776-2323
Mailing Address - Fax:617-623-6084
Practice Address - Street 1:396 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144
Practice Address - Country:US
Practice Address - Phone:617-776-2323
Practice Address - Fax:617-623-6084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA182551223G0001X
MA187671223G0001X
MA181741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty