Provider Demographics
NPI:1154481265
Name:TAHMASEBI-MOSHIRI, FARIBA (DMD)
Entity Type:Individual
Prefix:DR
First Name:FARIBA
Middle Name:
Last Name:TAHMASEBI-MOSHIRI
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 1:777 S NEW BALLAS RD STE 305W
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8719
Mailing Address - Country:US
Mailing Address - Phone:314-997-5151
Mailing Address - Fax:314-997-7554
Practice Address - Street 1:777 S NEW BALLAS RD STE 305W
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8719
Practice Address - Country:US
Practice Address - Phone:314-997-5151
Practice Address - Fax:314-997-7554
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0142941223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9177502OtherDORAL DENTAL
MO605104OtherCOMPDENT
MOAETNA PPOOtherAETNA PPO
MO103292OtherALLIANCE-BCBS