Provider Demographics
NPI:1336107291
Name:FARZANEH KESHMIRI DDS PA
Entity Type:Organization
Organization Name:FARZANEH KESHMIRI DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARZANEH
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHMIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-793-4211
Mailing Address - Street 1:5641 POPLAR TENT RD
Mailing Address - Street 2:STE 203
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027
Mailing Address - Country:US
Mailing Address - Phone:704-793-4211
Mailing Address - Fax:704-793-4210
Practice Address - Street 1:5641 POPLAR TENT RD
Practice Address - Street 2:STE 203
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027
Practice Address - Country:US
Practice Address - Phone:704-793-4211
Practice Address - Fax:704-793-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty