Provider Demographics
NPI:1396134896
Name:VIKTORIA P. TALEBIAN DMD PC
Entity type:Organization
Organization Name:VIKTORIA P. TALEBIAN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIKTORIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:TALEBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-745-2533
Mailing Address - Street 1:128 HIGHLAND AVENUE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-745-2533
Mailing Address - Fax:978-740-3238
Practice Address - Street 1:128 HIGHLAND AVENUE
Practice Address - Street 2:SUITE #1
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-745-2533
Practice Address - Fax:978-740-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA194281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty