Individual
BADRIEH EDALATPOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
68 NEW EDGERLY RD, BOSTON, MA 02115-3503
(617) 262-5880
(617) 859-8804
Mailing address
68 NEW EDGERLY RD, BOSTON, MA 02115-3503
(617) 262-5880
(617) 859-8804
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
19756
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0282685
—
MA
01
—
X10762
BLUE CROSS BLUE SHIELD
MA
Enumeration date
08/02/2006
Last updated
07/08/2007
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