Provider Demographics
NPI:1861901233
Name:DURRANI, PALWASHA JAN (DMD)
Entity type:Individual
Prefix:
First Name:PALWASHA
Middle Name:JAN
Last Name:DURRANI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 MASSACHUSETTS AVE APT 316
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3328
Mailing Address - Country:US
Mailing Address - Phone:617-794-8383
Mailing Address - Fax:
Practice Address - Street 1:714 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3308
Practice Address - Country:US
Practice Address - Phone:617-868-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857762122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist