Provider Demographics
NPI:1265416549
Name:DARROUDI, ELZEH MARYANN (DMD)
Entity type:Individual
Prefix:DR
First Name:ELZEH
Middle Name:MARYANN
Last Name:DARROUDI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5640
Mailing Address - Country:US
Mailing Address - Phone:617-277-4445
Mailing Address - Fax:617-738-2930
Practice Address - Street 1:1037 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5656
Practice Address - Country:US
Practice Address - Phone:617-277-4445
Practice Address - Fax:617-738-2930
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17265122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist