Provider Demographics
NPI:1831316132
Name:GHOBBEH, FARSHAD (DMD)
Entity Type:Individual
Prefix:MR
First Name:FARSHAD
Middle Name:
Last Name:GHOBBEH
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 1:406 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3309
Mailing Address - Country:US
Mailing Address - Phone:781-395-0300
Mailing Address - Fax:
Practice Address - Street 1:406 SALEM ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3309
Practice Address - Country:US
Practice Address - Phone:781-395-0300
Practice Address - Fax:781-395-0220
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21444122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist