Provider Demographics
NPI:1720123961
Name:MAHJOOBI, TARANEH (DMD)
Entity Type:Individual
Prefix:
First Name:TARANEH
Middle Name:
Last Name:MAHJOOBI
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 1:26 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1044
Mailing Address - Country:US
Mailing Address - Phone:603-886-0331
Mailing Address - Fax:
Practice Address - Street 1:19 TYLER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2951
Practice Address - Country:US
Practice Address - Phone:603-880-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH30381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice