Provider Demographics
NPI:1942313929
Name:GHORIESHI, ABBAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ABBAS
Middle Name:
Last Name:GHORIESHI
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 1:115 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861
Mailing Address - Country:US
Mailing Address - Phone:401-723-6565
Mailing Address - Fax:401-723-6611
Practice Address - Street 1:115 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861
Practice Address - Country:US
Practice Address - Phone:401-723-6565
Practice Address - Fax:401-723-6611
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI028031223P0300X
MA173771223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics