Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 014294 | MO |
NPI | 1154481265 |
---|---|
Provider Name | Dr. Fariba Tahmasebi-Moshiri |
First Address | Saint Louis, MO 63141-8719 |
Second Address | Saint Louis, MO 63141-8719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103292 | ALLIANCE-BCBS (01) | MO |
605104 | COMPDENT (01) | MO |
9177502 | DORAL DENTAL (01) | MO |
AETNA PPO | AETNA PPO (01) | MO |