Active NPI
Mariam Susanne Fallahzadeh, DMD
- General Practice Dentistry
- Paris, KY
National Provider Identifier
1235200205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 7770
- Practice address
- 4223A Lexington Road
Bourbon Family Dentistry PLLC
Paris, KY 40361 - Phone
- (859) 988-0308
- Fax
- (859) 988-0310
- NPI assigned
- Nov 13, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7770 | KY | Primary |
Addresses
Primary practice location
4223A Lexington Road
Bourbon Family Dentistry PLLC
Paris, KY 40361
Mailing address
4223A Lexington Road
Paris, KY 40361
Phone (859) 988-0308
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7770 | KY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bourbon Family Dentistry | General Practice | Past | Accepting new patients |
| Bourbon Family Dre PLLC | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1235200205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4223A LEXINGTON ROAD",
"city": "PARIS",
"state": "KY",
"postal_code": "40361",
"telephone_number": "859-988-0308",
"fax_number": "859-988-0310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4223A LEXINGTON ROAD",
"address_2": "BOURBON FAMILY DENTISTRY PLLC",
"city": "PARIS",
"state": "KY",
"postal_code": "40361",
"telephone_number": "859-988-0308",
"fax_number": "859-988-0310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FALLAHZADEH",
"first_name": "MARIAM",
"middle_name": "SUSANNE",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KY",
"license": "7770",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Paris, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.