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General NPI Number Information
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NPI Number | 1841485125
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Entity Type | Individual
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Provider Name | MARJAN KERMANSHAH DDS, MS
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Gender | Female
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 01/19/2010
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Provider Practice Location Address
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Address Line | 353 E 83RD ST GROUND LEVEL
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City | NEW YORK
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State | NY
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Zip | 10028-4337
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Country | US
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Telephone | 212-249-0877
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Fax | 212-249-1340
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Provider Business Mailing Address
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Address Line | 353 E 83RD ST GROUND LEVEL
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City | NEW YORK
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State | NY
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Zip | 10028-4337
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Country | US
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Telephone | 212-249-0877
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Fax | 212-249-1340
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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 | 051341
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02282200
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License Number State | NJ
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