Individual
SHAHRAM MOGHADDAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
396 HIGHLAND AVE, SOMERVILLE, MA 02144-2512
(617) 776-2323
Mailing address
396 HIGHLAND AVE, SOMERVILLE, MA 02144-2512
(617) 776-2323
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
18767
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0280925
—
MA
Enumeration date
03/08/2007
Last updated
07/09/2007
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