Provider Demographics
NPI:1588095327
Name:MONIRIAN, JAHAN RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:JAHAN
Middle Name:RICHARD
Last Name:MONIRIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1964
Mailing Address - Country:US
Mailing Address - Phone:617-846-1112
Mailing Address - Fax:617-207-1192
Practice Address - Street 1:313 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-1964
Practice Address - Country:US
Practice Address - Phone:617-846-1112
Practice Address - Fax:617-207-1192
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130427041223G0001X
MADN1856702122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice