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General NPI Number Information
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NPI Number | 1740499797
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Entity Type | Individual
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Provider Name | MARIAM VAZIRI D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 28 BEECHWOOD RD SUITE 2
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City | SUMMIT
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State | NJ
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Zip | 07901-2532
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Country | US
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Telephone | 978-692-6326
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Fax | 908-737-1353
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Provider Business Mailing Address
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Address Line | 28 BEECHWOOD RD SUITE 2
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City | SUMMIT
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State | NJ
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Zip | 07901-2532
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Country | US
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Telephone | 617-794-0889
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Fax | 908-737-1353
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 20045
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02098000
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License Number State | NJ
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