Active NPI
Amir Fereidouni, D.M.D., C.A.G.S.
- Dentist
- Medford, MA
National Provider Identifier
1841402500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 20309
- Practice address
- 3985 Mystic Valley Pkwy
Medford, MA 02155-0000 - Phone
- (781) 396-6613
- NPI assigned
- May 4, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 20309 | MA | Primary |
Addresses
Primary practice location
3985 Mystic Valley Pkwy
Medford, MA 02155-0000
Mailing address
3920 Mystic Valley Pkwy Apt 919
Medford, MA 02155-6910
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20309 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1841402500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3920 MYSTIC VALLEY PKWY APT 919",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021556910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3985 MYSTIC VALLEY PKWY",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021550000",
"telephone_number": "781-396-6613"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEREIDOUNI",
"first_name": "AMIR",
"credential": "D.M.D., C.A.G.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "20309",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.