Provider Demographics
NPI:1700432143
Name:MIDDLEBORO ORAL SURGEONS, PC
Entity Type:Organization
Organization Name:MIDDLEBORO ORAL SURGEONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHRAFI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-838-7100
Mailing Address - Street 1:47 BEDFORD ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1047
Mailing Address - Country:US
Mailing Address - Phone:508-947-8452
Mailing Address - Fax:
Practice Address - Street 1:47 BEDFORD ST UNIT 3
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1047
Practice Address - Country:US
Practice Address - Phone:508-947-8452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty