Provider Demographics
NPI:1598637282
Name:MEHRAN MASSOUMI DDS PLLC
Entity type:Organization
Organization Name:MEHRAN MASSOUMI DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER PLLC
Authorized Official - Prefix:
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSAOUMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-635-4666
Mailing Address - Street 1:80 SHUNPIKE RD UNIT 201
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-4402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 SHUNPIKE RD UNIT 201
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-4402
Practice Address - Country:US
Practice Address - Phone:860-635-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental