Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 22DI02360200 | NJ |
NPI | 1013219575 |
---|---|
Provider Name | Daryoush Haghighi |
First Address | Montclair, NJ 07042-2626 |
Second Address | Montclair, NJ 07042-2626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2010 |
Last Update Date | 22/06/2011 |