Provider Demographics
NPI:1043440365
Name:FALLAHI, SUSAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:FALLAHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 S CORTEZ ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6903
Mailing Address - Country:US
Mailing Address - Phone:513-550-2452
Mailing Address - Fax:
Practice Address - Street 1:3715 PRYTANIA ST STE 380
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3762
Practice Address - Country:US
Practice Address - Phone:504-896-7435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2018-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023083122300000X
LA62591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist