Provider Demographics
NPI:1922283647
Name:MONTAZERI, MARYA F (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARYA
Middle Name:F
Last Name:MONTAZERI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 MASS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474
Mailing Address - Country:US
Mailing Address - Phone:781-646-7008
Mailing Address - Fax:781-646-9123
Practice Address - Street 1:63 MASS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02974
Practice Address - Country:US
Practice Address - Phone:781-646-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA197881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice