MEDICARE: DR. MARYAM JAHANSOUZ D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	21766	NJ

General Provider Information

NPI Number	:	1366509010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARYAM JAHANSOUZ D.D.S.

Provider Business Mailing Address
First Line	:	139 SAND RD
Second Line	:
City	:	WESTWOOD
State	:	NJ
Zip	:	07675-2419
Country	:	US
Telephone Number	:	201-965-0087
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 CEDAR LN STE 203
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-3444
Country	:	US
Telephone Number	:	201-488-1164
Fax Number	:	201-488-1137

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	10/21/2024

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