Provider Demographics
NPI:1083277032
Name:PEARL DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:PEARL DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER / OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:PEZESHKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-883-6010
Mailing Address - Street 1:76 NORTHEASTERN BLVD UNIT 35
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3174
Mailing Address - Country:US
Mailing Address - Phone:603-883-6010
Mailing Address - Fax:603-883-6802
Practice Address - Street 1:76 NORTHEASTERN BLVD UNIT 35
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3174
Practice Address - Country:US
Practice Address - Phone:603-883-6010
Practice Address - Fax:603-883-6802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental