Provider Demographics
NPI:1902925530
Name:RAHMATPOUR LLC, MEHDI (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEHDI
Middle Name:
Last Name:RAHMATPOUR LLC
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CEDAR ST
Mailing Address - Street 2:APT 401
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-3597
Mailing Address - Country:US
Mailing Address - Phone:617-686-2226
Mailing Address - Fax:617-567-5454
Practice Address - Street 1:79 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1959
Practice Address - Country:US
Practice Address - Phone:617-567-8882
Practice Address - Fax:617-567-5454
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA197571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice