Provider Demographics
NPI:1093353526
Name:NADER MOAVENIAN, DDS PA
Entity Type:Organization
Organization Name:NADER MOAVENIAN, DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-595-8889
Mailing Address - Street 1:33 TRAFALGAR SQ STE 201
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-4901
Mailing Address - Country:US
Mailing Address - Phone:603-595-8889
Mailing Address - Fax:603-595-2027
Practice Address - Street 1:5 SHEEP DAVIS RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NH
Practice Address - Zip Code:03275-3702
Practice Address - Country:US
Practice Address - Phone:603-224-7831
Practice Address - Fax:603-224-8549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty