Individual
BAHRAM GHASSEMI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
68 NEW EDGERLY RD, BOSTON, MA 02115
(617) 262-5880
(617) 859-8804
Mailing address
68 NEW EDGERLY RD, BOSTON, MA 02115
(617) 262-5880
(617) 859-8804
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
13913
MA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
13913
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0268631
—
MA
01
—
100437
DELTA DENTAL
MA
01
—
X10762
BLUE CROSS BLUE SHIELD
MA
Enumeration date
08/09/2006
Last updated
02/19/2013
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