Individual
MIRA KHOUZAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
394 LOWELL ST STE 2, LEXINGTON, MA 02420-2575
(781) 656-5321
Mailing address
2350 COMMONWEALTH AVE APT 1-2, AUBURNDALE, MA 02466-1727
(857) 265-9644
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN1857394
MA
Other
Enumeration date
08/21/2016
Last updated
08/21/2016
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