Provider Demographics
NPI:1881435352
Name:RAZAVI, NINA (DMD)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:RAZAVI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SEAPORT BLVD UNIT 1416
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-2167
Mailing Address - Country:US
Mailing Address - Phone:813-777-2972
Mailing Address - Fax:
Practice Address - Street 1:481 OLD POST RD UNIT A
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-4244
Practice Address - Country:US
Practice Address - Phone:508-695-7031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADEN1005261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice