Provider Demographics
NPI:1679820815
Name:DARVISH, ADAM NOURI (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:NOURI
Last Name:DARVISH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MEADOW WOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1516
Mailing Address - Country:US
Mailing Address - Phone:774-232-3136
Mailing Address - Fax:
Practice Address - Street 1:15 SALEM ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2006
Practice Address - Country:US
Practice Address - Phone:774-232-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18561031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice