Provider Demographics
NPI:1467468702
Name:EMAMIAN, SHOKOUFEH (DMD)
Entity Type:Individual
Prefix:
First Name:SHOKOUFEH
Middle Name:
Last Name:EMAMIAN
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 1:247 PENN AVE
Mailing Address - Street 2:FORUM DENTAL ASSOCIATES PC
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503
Mailing Address - Country:US
Mailing Address - Phone:570-343-0643
Mailing Address - Fax:
Practice Address - Street 1:247 PENN AVE
Practice Address - Street 2:FORUM DENTAL ASSOCIATES PC
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503
Practice Address - Country:US
Practice Address - Phone:570-343-0643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029199L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics