Provider Demographics
NPI:1720158942
Name:RAMESH IZEDIAN DMD & SHOHRAM MOGHADDAM DMD PC
Entity Type:Organization
Organization Name:RAMESH IZEDIAN DMD & SHOHRAM MOGHADDAM DMD PC
Other - Org Name:COSMETIC DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:IZEDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-662-1999
Mailing Address - Street 1:3 WOODLAND RD
Mailing Address - Street 2:STE 417
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180
Mailing Address - Country:US
Mailing Address - Phone:781-662-1999
Mailing Address - Fax:781-662-4430
Practice Address - Street 1:3 WOODLAND RD
Practice Address - Street 2:STE 417
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180
Practice Address - Country:US
Practice Address - Phone:781-662-1999
Practice Address - Fax:781-662-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18174122300000X
MA18767122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty