Provider Demographics
NPI:1053444703
Name:IRANI, FARIBA (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARIBA
Middle Name:
Last Name:IRANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:FARIBA
Other - Middle Name:
Other - Last Name:MAGHADDASSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:64 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-6619
Mailing Address - Country:US
Mailing Address - Phone:516-942-5352
Mailing Address - Fax:
Practice Address - Street 1:40 CROSSWAYS PARK DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2036
Practice Address - Country:US
Practice Address - Phone:516-921-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046180-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist