Provider Demographics
NPI:1538261755
Name:JAVID, MEHRAN (DMD)
Entity type:Individual
Prefix:
First Name:MEHRAN
Middle Name:
Last Name:JAVID
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 1:1351 S COUNTY TRL # 120
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5079
Mailing Address - Country:US
Mailing Address - Phone:401-541-9161
Mailing Address - Fax:401-541-9162
Practice Address - Street 1:1351 S COUNTY TRL # 120
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5079
Practice Address - Country:US
Practice Address - Phone:401-541-9161
Practice Address - Fax:401-541-9162
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI02576122300000X
MA185591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMJ02576Medicaid
RI02576OtherDELTA DENTAL OF RI
RI8544-5OtherBC/BS OF RI