Provider Demographics
NPI:1740385459
Name:DAMGHANI, GOLNAZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:GOLNAZ
Middle Name:
Last Name:DAMGHANI
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 1:131 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-6636
Mailing Address - Country:US
Mailing Address - Phone:781-893-7500
Mailing Address - Fax:781-893-9090
Practice Address - Street 1:131 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-6636
Practice Address - Country:US
Practice Address - Phone:781-893-7500
Practice Address - Fax:781-893-9090
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA194081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice