1922153121 NPI number — MRS. MAHKAMEH SOLEIMANI FARNAD DDS

Table of content: MRS. MAHKAMEH SOLEIMANI FARNAD DDS (NPI 1922153121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922153121 NPI number — MRS. MAHKAMEH SOLEIMANI FARNAD DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOLEIMANI FARNAD
Provider First Name:
MAHKAMEH
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOLEIMANI
Provider Other First Name:
MAHKAMEH
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922153121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2840 HYLANE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-642-7016
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7743 GRAND RIVER AVE
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-222-9030
Provider Business Practice Location Address Fax Number:
810-229-7361
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2901019489 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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