Provider Demographics
NPI:1467999664
Name:SHIRIN FAKHRI D.D.S. P.C.
Entity Type:Organization
Organization Name:SHIRIN FAKHRI D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAKHRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-879-4565
Mailing Address - Street 1:2885 E LONG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4100
Mailing Address - Country:US
Mailing Address - Phone:248-879-4565
Mailing Address - Fax:248-879-4515
Practice Address - Street 1:2885 E LONG LAKE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-4100
Practice Address - Country:US
Practice Address - Phone:248-879-4565
Practice Address - Fax:248-879-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010179301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty