Provider Demographics
NPI:1891718961
Name:MOHEBAN, DANIEL B (DMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:MOHEBAN
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 1:200 LINCOLN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2528
Mailing Address - Country:US
Mailing Address - Phone:508-756-6264
Mailing Address - Fax:508-756-6490
Practice Address - Street 1:200 LINCOLN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2528
Practice Address - Country:US
Practice Address - Phone:508-756-6264
Practice Address - Fax:508-756-6490
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry