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General NPI Number Information
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NPI Number | 1225609514
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Entity Type | Organization
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Legal Business Name | RADMANESH DENTAL PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/07/2021
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 33 E CONCORD ST UNIT 2
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City | BOSTON
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State | MA
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Zip | 02118-1905
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Country | US
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Telephone | 857-264-8063
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Fax |
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Provider Business Mailing Address
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Address Line | 1267 WILLIS ST STE 200
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City | REDDING
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State | CA
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Zip | 96001-0400
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PARHAM RADMANESH
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Credential | DMD
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Telephone | 857-264-8063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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