Organization
NISTAR PEDIATRIC DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAHNAAZ NISTAR DDS (DENTIST)
(917) 892-3625
Entity
Organization
Contact information
Practice address
76 MERRIMACK ST STE 8A, HAVERHILL, MA 01830-6246
(917) 892-3625
Mailing address
45 OWENCROFT RD, BOSTON, MA 02124-4723
(917) 892-3625
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952610008
—
MA
Enumeration date
12/05/2019
Last updated
12/05/2019
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