Individual
DR. SEVARA MAMADALIMOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
635 ALBANY ST, BOSTON, MA 02118
(617) 358-8360
Mailing address
761 HARRISON AVE APT 110, BOSTON, MA 02118-2362
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12014241A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12014241A
INDIANA DENTAL BOARD
IN
01
—
DL14967
MASSACHUSETTS DENTAL LICENSE - LIMITED LICENSE
MA
Enumeration date
12/16/2021
Last updated
11/21/2023
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