Provider Demographics
NPI:1083741268
Name:ESLAMBOLTCHI, FARHAD (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:FARHAD
Middle Name:
Last Name:ESLAMBOLTCHI
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:FARHAD
Other - Middle Name:E
Other - Last Name:BOLTCHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD MS
Mailing Address - Street 1:800 W ARBROOK BLVD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015
Mailing Address - Country:US
Mailing Address - Phone:817-467-7731
Mailing Address - Fax:817-472-6393
Practice Address - Street 1:800 W ARBROOK BLVD
Practice Address - Street 2:SUITE 360
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015
Practice Address - Country:US
Practice Address - Phone:817-467-7731
Practice Address - Fax:817-472-6393
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192471223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics