Provider Demographics
NPI:1245935162
Name:WAHID, HAFSA
Entity type:Individual
Prefix:
First Name:HAFSA
Middle Name:
Last Name:WAHID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 BOYLSTON ST UNIT 1225
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4464
Mailing Address - Country:US
Mailing Address - Phone:214-801-9628
Mailing Address - Fax:
Practice Address - Street 1:20 HOLLAND ST STE 400
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2749
Practice Address - Country:US
Practice Address - Phone:617-326-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN10000475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist