Provider Demographics
NPI:1306824438
Name:FARHANG FALLAH, JINOOS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JINOOS
Middle Name:
Last Name:FARHANG FALLAH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 PARKER RD SE
Mailing Address - Street 2:# 1205
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-2603
Mailing Address - Country:US
Mailing Address - Phone:770-760-7932
Mailing Address - Fax:
Practice Address - Street 1:1816 LAKEFIELD CT SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6609
Practice Address - Country:US
Practice Address - Phone:770-860-8760
Practice Address - Fax:678-413-8144
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012773122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist