Provider Demographics
NPI:1962757088
Name:SAMAD-ZADEH, ARMAN
Entity type:Individual
Prefix:
First Name:ARMAN
Middle Name:
Last Name:SAMAD-ZADEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 FARMINGTON AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1544
Mailing Address - Country:US
Mailing Address - Phone:860-232-0033
Mailing Address - Fax:
Practice Address - Street 1:836 FARMINGTON AVE STE 115
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119
Practice Address - Country:US
Practice Address - Phone:617-571-9089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-15
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT122611223E0200X
MADN1855810122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist