Provider Demographics
NPI:1346890761
Name:FARRAGUT FAMILY ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:FARRAGUT FAMILY ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:SARANJAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-751-8206
Mailing Address - Street 1:818 18TH ST NW STE 747
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-3513
Mailing Address - Country:US
Mailing Address - Phone:240-751-8206
Mailing Address - Fax:
Practice Address - Street 1:818 18TH ST NW STE 747
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-3513
Practice Address - Country:US
Practice Address - Phone:240-751-8206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC097075600Medicaid