Provider Demographics
NPI:1174984470
Name:JALILI FAZEL, FARBOD (DDS)
Entity type:Individual
Prefix:DR
First Name:FARBOD
Middle Name:
Last Name:JALILI FAZEL
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 1:2727 BRYANT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4250
Mailing Address - Country:US
Mailing Address - Phone:720-220-5991
Mailing Address - Fax:
Practice Address - Street 1:2727 BRYANT ST STE 101
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4250
Practice Address - Country:US
Practice Address - Phone:720-456-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00203124122300000X
CO002031241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist