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Individual
MARJAN KERMANSHAH
Active
Individual
MARJAN KERMANSHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS, MS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
22DI02282200
NJ
1223G0001X
General Practice Dentistry
Primary
051341
NY
Other
Enumeration date
09/11/2007
Last updated
01/19/2010
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