Provider Demographics
NPI:1043462658
Name:GULDALIAN, TALAR
Entity Type:Individual
Prefix:
First Name:TALAR
Middle Name:
Last Name:GULDALIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MIDDLESEX RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-1028
Mailing Address - Country:US
Mailing Address - Phone:978-649-3304
Mailing Address - Fax:
Practice Address - Street 1:304 CAMBRIDGE RD STE 340
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6033
Practice Address - Country:US
Practice Address - Phone:781-369-5722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220471223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics