Provider Demographics
NPI:1407957392
Name:ALLEN, FARNOUSH (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARNOUSH
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 GREENWAY CENTER DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3502
Mailing Address - Country:US
Mailing Address - Phone:301-474-2505
Mailing Address - Fax:301-474-2507
Practice Address - Street 1:7500 GREENWAY CENTER DR
Practice Address - Street 2:SUITE 120
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3502
Practice Address - Country:US
Practice Address - Phone:301-474-2505
Practice Address - Fax:301-474-2507
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD120001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice