Provider Demographics
NPI:1720741069
Name:JAVAD MIRZAI DMD PLLC
Entity Type:Organization
Organization Name:JAVAD MIRZAI DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-877-8884
Mailing Address - Street 1:234 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3823
Mailing Address - Country:US
Mailing Address - Phone:617-877-5884
Mailing Address - Fax:
Practice Address - Street 1:49 CROSS STREET EXT
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2209
Practice Address - Country:US
Practice Address - Phone:617-877-5884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty