1730424771 NPI number — DR. FARZAN LEONARDO POURANFAR DMD

Table of content: DR. FARZAN LEONARDO POURANFAR DMD (NPI 1730424771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730424771 NPI number — DR. FARZAN LEONARDO POURANFAR DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POURANFAR
Provider First Name:
FARZAN
Provider Middle Name:
LEONARDO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730424771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BAUMHOLDER DENTAL CLINIC
Provider Second Line Business Mailing Address:
8647 SMITH BARRACKS
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BAUMHOLDER DENTAL CLINIC
Provider Second Line Business Practice Location Address:
8647 SMITH BARRACKS
Provider Business Practice Location Address City Name:
BAUMHOLDER
Provider Business Practice Location Address State Name:
REILANDFALS
Provider Business Practice Location Address Postal Code:
09034
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
149-458-2240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2012

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: 1223G0001X , with the licence number:  9175 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com