Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 30.023083 | OH |
Y | 1223P0221X | Pediatric Dentist | 6259 | LA |
NPI | 1043440365 |
---|---|
Provider Name | Dr. Susan Fallahi |
First Address | New Orleans, LA 70119-6903 |
Second Address | New Orleans, LA 70115-3762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2009 |
Last Update Date | 13/10/2018 |