Provider Demographics
NPI:1962571604
Name:TABATABAI, FOROUGH (DMD)
Entity type:Individual
Prefix:MRS
First Name:FOROUGH
Middle Name:
Last Name:TABATABAI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 WASHINGTON ST
Mailing Address - Street 2:#312
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801
Mailing Address - Country:US
Mailing Address - Phone:781-938-5100
Mailing Address - Fax:781-938-6389
Practice Address - Street 1:444 WASHINGTON ST
Practice Address - Street 2:#312
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801
Practice Address - Country:US
Practice Address - Phone:781-938-5100
Practice Address - Fax:781-938-6389
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17496122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist