Provider Demographics
NPI:1073503504
Name:SANI, FARZAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARZAD
Middle Name:
Last Name:SANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4382
Mailing Address - Country:US
Mailing Address - Phone:518-798-9966
Mailing Address - Fax:518-798-0616
Practice Address - Street 1:88 BROAD ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4382
Practice Address - Country:US
Practice Address - Phone:518-798-9966
Practice Address - Fax:518-798-0616
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0507571223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000404001005OtherBLUE SHIELD
NY0017845OtherDORAL DENTAL
NY02410617Medicaid
NY10072379OtherCDPHP
NY000404001003OtherBLUE SHIELD
NY000404001004OtherBLUE SHIELD