Provider Demographics
NPI:1679042758
Name:ESHAGHI, PRANA (DMD)
Entity Type:Individual
Prefix:
First Name:PRANA
Middle Name:
Last Name:ESHAGHI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SEYEDE MAHDIEH
Other - Middle Name:
Other - Last Name:ESHAGHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:24 LESLIE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2923
Mailing Address - Country:US
Mailing Address - Phone:617-955-1589
Mailing Address - Fax:
Practice Address - Street 1:24 LESLIE RD
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-2923
Practice Address - Country:US
Practice Address - Phone:617-955-1589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-18
Last Update Date:2018-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858155122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist