Organization
M MOHEBAN DMD PC
Active
Other names
advanced dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANSOUR MOHEBAN DMD (PRESIDENT)
(508) 393-2522
Entity
Organization
Contact information
Practice address
154 MAIN ST, NORTHBOROUGH, MA 01532-1930
(508) 393-2522
(508) 393-9782
Mailing address
154 MAIN ST, NORTHBOROUGH, MA 01532-1930
(508) 393-2522
(508) 393-9782
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11905
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1331231
UNITED CONCORDIA
MA
01
—
262609
MASS HEALTH
MA
01
—
38400
HARVARD PILGRIM
MA
01
—
X12350
BCBS MA
MA
01
—
X12351
BCBS MA
MA
01
—
X12515
BCBS MA
MA
Enumeration date
06/02/2008
Last updated
06/02/2008
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