Provider Demographics
NPI:1043498983
Name:ATHARI, FARNAZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARNAZ
Middle Name:
Last Name:ATHARI
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 1:3701 W NORTHWEST HWY STE 306
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-4962
Mailing Address - Country:US
Mailing Address - Phone:702-275-9460
Mailing Address - Fax:
Practice Address - Street 1:3701 W NORTHWEST HWY STE 306
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4962
Practice Address - Country:US
Practice Address - Phone:702-275-9460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5629122300000X
TX27586122300000X
CA56275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist