Provider Demographics
NPI:1205962396
Name:KALALI, MINA HOJABR (DMD)
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:HOJABR
Last Name:KALALI
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 1:78 NORTHEASTERN BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062
Mailing Address - Country:US
Mailing Address - Phone:603-880-5002
Mailing Address - Fax:603-880-1877
Practice Address - Street 1:78 NORTHEASTERN BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062
Practice Address - Country:US
Practice Address - Phone:603-880-5002
Practice Address - Fax:603-880-1877
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH33741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30303168Medicaid