Provider Demographics
NPI:1083067599
Name:SHARIFI, FARHAD
Entity Type:Individual
Prefix:
First Name:FARHAD
Middle Name:
Last Name:SHARIFI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 S PIERPONT DR
Mailing Address - Street 2:UNIT 2046
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206
Mailing Address - Country:US
Mailing Address - Phone:858-444-7391
Mailing Address - Fax:
Practice Address - Street 1:1941 S PIERPONT DR
Practice Address - Street 2:UNIT 2046
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:858-444-7391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist