Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 19428 | MA |
NPI | 1013020031 |
---|---|
Provider Name | Dr. Viktoria Talebian |
First Address | Salem, MA 01970-2724 |
Second Address | Salem, MA 01970-2724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1390890 | UNITED CONCORDIA PROV. # (01) | MA |
X11417 | BCBS PROVIDER NUMBER (01) | MA |