Provider Demographics
NPI:1942432984
Name:MOKTI, MUIZZADDIN (BDS)
Entity Type:Individual
Prefix:DR
First Name:MUIZZADDIN
Middle Name:
Last Name:MOKTI
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 BEACON ST
Mailing Address - Street 2:APARTMENT 717
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2092
Mailing Address - Country:US
Mailing Address - Phone:857-891-8038
Mailing Address - Fax:
Practice Address - Street 1:188 LONGWOOD AVE
Practice Address - Street 2:HARVARD SCHOOL OF DENTAL MEDICINE, ROOM 223
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5819
Practice Address - Country:US
Practice Address - Phone:617-432-1790
Practice Address - Fax:617-432-0901
Is Sole Proprietor?:No
Enumeration Date:2009-08-09
Last Update Date:2009-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL107171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice