Provider Demographics
NPI:1902923774
Name:JAFFARIAN, MARY VICTORIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:VICTORIA
Last Name:JAFFARIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-6545
Mailing Address - Country:US
Mailing Address - Phone:401-574-0661
Mailing Address - Fax:
Practice Address - Street 1:1144 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-7033
Practice Address - Country:US
Practice Address - Phone:508-790-0178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217271223G0001X
MADN21727122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMJ6240OtherRI MEDICAL ASSISTANCE PRO