Provider Demographics
NPI:1558586081
Name:GHAFFARI, FOROUZAN (DMD)
Entity Type:Individual
Prefix:
First Name:FOROUZAN
Middle Name:
Last Name:GHAFFARI
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 1:700 PASSAIC AVE
Mailing Address - Street 2:DENTAL GROUP
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6408
Mailing Address - Country:US
Mailing Address - Phone:973-227-8188
Mailing Address - Fax:973-299-5151
Practice Address - Street 1:700 PASSAIC AVE
Practice Address - Street 2:DENTAL GROUP
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6408
Practice Address - Country:US
Practice Address - Phone:973-227-8188
Practice Address - Fax:973-299-5151
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02002700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist