Provider Demographics
NPI:1962469908
Name:VAKILI, NADER
Entity Type:Individual
Prefix:
First Name:NADER
Middle Name:
Last Name:VAKILI
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 1:32 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8302
Mailing Address - Country:US
Mailing Address - Phone:508-270-2787
Mailing Address - Fax:
Practice Address - Street 1:32 CONCORD ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8302
Practice Address - Country:US
Practice Address - Phone:508-270-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049163-1122300000X
MA21319122300000X
MADN213191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist