Provider Demographics
NPI:1972533719
Name:EBTAHAJ, ROOHI (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:ROOHI
Middle Name:
Last Name:EBTAHAJ
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HORIZONS RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2765
Mailing Address - Country:US
Mailing Address - Phone:781-784-0063
Mailing Address - Fax:
Practice Address - Street 1:510 THACHER ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3551
Practice Address - Country:US
Practice Address - Phone:508-222-3434
Practice Address - Fax:508-222-3431
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157481223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics