Basic Information
| Provider Information | |||||||||
| NPI: | 1255767380 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAGHER | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | MUSTAFA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | BDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 MCCOBA ST | ||||||||
| Address2: | APARTMENT 61 | ||||||||
| City: | REVERE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021511229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8572597549 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 KNEELAND ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021111527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176366971 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2013 | ||||||||
| LastUpdateDate: | 09/20/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | DL11737 | MA | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.