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General NPI Number Information
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NPI Number | 1083277032
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Entity Type | Organization
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Legal Business Name | PEARL DENTAL ASSOCIATES
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Dates
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Enumeration Date | 04/16/2019
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | 76 NORTHEASTERN BLVD UNIT 35
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City | NASHUA
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State | NH
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Zip | 03062-3174
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Country | US
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Telephone | 603-883-6010
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Fax | 603-883-6802
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Provider Business Mailing Address
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Address Line | 76 NORTHEASTERN BLVD UNIT 35
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City | NASHUA
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State | NH
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Zip | 03062-3174
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Country | US
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Telephone | 603-883-6010
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Fax | 603-883-6802
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Authorized Official
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Title or Position | MANAGER / OWNER/PRESIDENT
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Name | DR. FARSHAD PEZESHKI
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Credential | DMD
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Telephone | 603-883-6010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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