Healthcare Provider Details

I. General information

NPI: 1043440365
Provider Name (Legal Business Name): SUSAN FALLAHI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 10/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 PRYTANIA ST STE 380
NEW ORLEANS LA
70115-3762
US

IV. Provider business mailing address

422 S CORTEZ ST
NEW ORLEANS LA
70119-6903
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-7435
  • Fax:
Mailing address:
  • Phone: 513-550-2452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30.023083
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6259
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: