Provider Demographics
NPI:1861540221
Name:ADELI, ALEX (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:ADELI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ALIREZA
Other - Middle Name:
Other - Last Name:ADELI-NADJAFI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:575 BOYLSTON ST FL 7
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3607
Mailing Address - Country:US
Mailing Address - Phone:617-267-3889
Mailing Address - Fax:
Practice Address - Street 1:575 BOYLSTON ST FL 7
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3607
Practice Address - Country:US
Practice Address - Phone:617-267-3889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice