Provider Demographics
NPI:1972640605
Name:MOEINZAD, HASSAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:
Last Name:MOEINZAD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1542
Mailing Address - Country:US
Mailing Address - Phone:508-378-3442
Mailing Address - Fax:508-378-3990
Practice Address - Street 1:42 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1542
Practice Address - Country:US
Practice Address - Phone:508-378-3442
Practice Address - Fax:508-378-3990
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0205583Medicaid