Provider Demographics
NPI:1457113920
Name:SIRIANI, FOUAD (DMD)
Entity type:Individual
Prefix:
First Name:FOUAD
Middle Name:
Last Name:SIRIANI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 TERRACE HALL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-3408
Mailing Address - Country:US
Mailing Address - Phone:781-362-2260
Mailing Address - Fax:
Practice Address - Street 1:113 TERRACE HALL AVE STE 1
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3408
Practice Address - Country:US
Practice Address - Phone:781-362-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN10000944122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6942T882601Medicaid