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Organization

CITIDENTAL, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. PEYMAN KHADIVI DDS (OWNER)
(617) 723-6300
Entity
Organization

Contact information

Practice address
63 COURT ST, BOSTON, MA 02108-2109
(617) 723-6300
(617) 723-1717
Mailing address
63 COURT ST, BOSTON, MA 02108-2109
(617) 723-6300
(617) 723-1717

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
18609
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1725478
UNITED CONCORDIA
PA
01
X12378
BLUECROSS BLUESHIELD
MA
Enumeration date
05/31/2007
Last updated
08/22/2020
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