Provider Demographics
NPI:1871241968
Name:ASHA, FARNAZ (DMD)
Entity Type:Individual
Prefix:
First Name:FARNAZ
Middle Name:
Last Name:ASHA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TREMONT ST STE 402
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-2062
Mailing Address - Country:US
Mailing Address - Phone:617-523-2459
Mailing Address - Fax:617-523-2511
Practice Address - Street 1:73 LITCHFIELD ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1215
Practice Address - Country:US
Practice Address - Phone:781-346-4297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18593001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice