Provider Demographics
NPI:1053982793
Name:TAFESH, MOHAMMED (BDS, DMD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:TAFESH
Suffix:
Gender:M
Credentials:BDS, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HARRISON AVE UNIT 230
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2823
Mailing Address - Country:US
Mailing Address - Phone:949-531-9594
Mailing Address - Fax:
Practice Address - Street 1:843 WORCESTER ST STE G
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-2084
Practice Address - Country:US
Practice Address - Phone:508-270-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-04
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18590211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice