Provider Demographics
NPI:1942667811
Name:FOULADI, MEHRZAD (DDS)
Entity Type:Individual
Prefix:
First Name:MEHRZAD
Middle Name:
Last Name:FOULADI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MEHRZAD
Other - Middle Name:
Other - Last Name:ERFANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:6155 98TH ST
Mailing Address - Street 2:APT#6C
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1434
Mailing Address - Country:US
Mailing Address - Phone:718-592-5728
Mailing Address - Fax:
Practice Address - Street 1:115 E 61ST ST
Practice Address - Street 2:#6D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8183
Practice Address - Country:US
Practice Address - Phone:212-583-7605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-24
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047370-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist