Provider Demographics
NPI:1871817833
Name:FAMILY DENTAL CARE OF STONEHAM
Entity Type:Organization
Organization Name:FAMILY DENTAL CARE OF STONEHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ZIBA
Authorized Official - Middle Name:AZIM
Authorized Official - Last Name:SHIRAZI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-438-1003
Mailing Address - Street 1:272 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3505
Mailing Address - Country:US
Mailing Address - Phone:781-438-1003
Mailing Address - Fax:781-438-3303
Practice Address - Street 1:272 MAIN ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3505
Practice Address - Country:US
Practice Address - Phone:781-438-1003
Practice Address - Fax:781-438-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty