Provider Demographics
NPI:1639465396
Name:DANESHI, MONA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:
Last Name:DANESHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BARTLETT ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1334
Mailing Address - Country:US
Mailing Address - Phone:978-425-1496
Mailing Address - Fax:
Practice Address - Street 1:33 BARTLETT ST
Practice Address - Street 2:SUITE 501
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1334
Practice Address - Country:US
Practice Address - Phone:978-425-1496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN18561911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program