Provider Demographics
NPI:1275762890
Name:ZAMANI, FARIDOON (DMD, DDS)
Entity Type:Individual
Prefix:DR
First Name:FARIDOON
Middle Name:
Last Name:ZAMANI
Suffix:
Gender:M
Credentials:DMD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WASHINGTON ST STE 208
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-4949
Mailing Address - Country:US
Mailing Address - Phone:617-277-2666
Mailing Address - Fax:617-278-9880
Practice Address - Street 1:310 WASHINGTON ST STE 208
Practice Address - Street 2:
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-4949
Practice Address - Country:US
Practice Address - Phone:617-277-2666
Practice Address - Fax:617-278-9880
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA173381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0200701Medicaid