Provider Demographics
NPI:1740638667
Name:MODERN DENTISTRY LLC
Entity type:Organization
Organization Name:MODERN DENTISTRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:KARIMIPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-935-7536
Mailing Address - Street 1:307 GRAFTON ST
Mailing Address - Street 2:202-203
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-6236
Mailing Address - Country:US
Mailing Address - Phone:508-842-8838
Mailing Address - Fax:508-842-6356
Practice Address - Street 1:307 GRAFTON ST
Practice Address - Street 2:202-203
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-6236
Practice Address - Country:US
Practice Address - Phone:508-842-8838
Practice Address - Fax:508-842-6356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty