Provider Demographics
NPI:1649465543
Name:SALOME FARZANEH D.M.D.
Entity type:Organization
Organization Name:SALOME FARZANEH D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:DUMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-894-4424
Mailing Address - Street 1:212 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-4206
Mailing Address - Country:US
Mailing Address - Phone:178-189-4442
Mailing Address - Fax:781-893-6261
Practice Address - Street 1:212 CHARLES ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-4206
Practice Address - Country:US
Practice Address - Phone:178-189-4442
Practice Address - Fax:781-893-6261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty