Provider Demographics
NPI:1659541928
Name:NIARAKI, FAEZE FADIANI (DMD, MS)
Entity Type:Individual
Prefix:
First Name:FAEZE
Middle Name:FADIANI
Last Name:NIARAKI
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 BURNCOAT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-3130
Mailing Address - Country:US
Mailing Address - Phone:508-853-4003
Mailing Address - Fax:
Practice Address - Street 1:365 BURNCOAT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-3130
Practice Address - Country:US
Practice Address - Phone:508-853-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0147741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics