Provider Demographics
NPI:1235280652
Name:NEZAKATGOO, LEILA (DMD)
Entity type:Individual
Prefix:DR
First Name:LEILA
Middle Name:
Last Name:NEZAKATGOO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 OAK ST APT 201C
Mailing Address - Street 2:
Mailing Address - City:NEWTON UPPER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1452
Mailing Address - Country:US
Mailing Address - Phone:202-277-6730
Mailing Address - Fax:
Practice Address - Street 1:234 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-3735
Practice Address - Country:US
Practice Address - Phone:978-562-3330
Practice Address - Fax:978-922-0037
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18581021223X0400X
MD136221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics