Provider Demographics
NPI:1740941426
Name:ALI MASHAYEKHI DMD FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:ALI MASHAYEKHI DMD FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHAYEKHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-350-5578
Mailing Address - Street 1:0 GOVERNORS AVE STE 23
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3098
Mailing Address - Country:US
Mailing Address - Phone:781-350-5578
Mailing Address - Fax:
Practice Address - Street 1:0 GOVERNORS AVE STE 23
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3098
Practice Address - Country:US
Practice Address - Phone:781-350-5578
Practice Address - Fax:781-350-5583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental