Provider Demographics
NPI:1003400805
Name:COOP CITYDENTAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:COOP CITYDENTAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROKHZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-232-7067
Mailing Address - Street 1:2063B BARTOW AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4613
Mailing Address - Country:US
Mailing Address - Phone:718-379-4734
Mailing Address - Fax:718-379-6487
Practice Address - Street 1:2063B BARTOW AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4613
Practice Address - Country:US
Practice Address - Phone:718-379-4734
Practice Address - Fax:718-379-6487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty