Provider Demographics
NPI:1255767380
Name:BAGHER, SARA MUSTAFA (BDS)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:MUSTAFA
Last Name:BAGHER
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MCCOBA ST
Mailing Address - Street 2:APARTMENT 61
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1229
Mailing Address - Country:US
Mailing Address - Phone:857-259-7549
Mailing Address - Fax:
Practice Address - Street 1:1 KNEELAND ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1527
Practice Address - Country:US
Practice Address - Phone:617-636-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL117371223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry