Provider Demographics
NPI:1093876989
Name:PEZESHKI, FARSHAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:FARSHAD
Middle Name:
Last Name:PEZESHKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1413
Mailing Address - Country:US
Mailing Address - Phone:617-354-3300
Mailing Address - Fax:
Practice Address - Street 1:19 WHITE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1413
Practice Address - Country:US
Practice Address - Phone:617-354-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice