Provider Demographics
NPI:1346985843
Name:ARFAEE, NICKY MASOODI (DMD)
Entity Type:Individual
Prefix:
First Name:NICKY
Middle Name:MASOODI
Last Name:ARFAEE
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 1:10989 S RIVER FRONT PKWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095
Mailing Address - Country:US
Mailing Address - Phone:407-446-8436
Mailing Address - Fax:
Practice Address - Street 1:10989 S RIVER FRONT PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095
Practice Address - Country:US
Practice Address - Phone:407-446-8436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2023-12-21
Deactivation Date:2023-10-08
Deactivation Code:
Reactivation Date:2023-11-28
Provider Licenses
StateLicense IDTaxonomies
FLDN27986122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist