Provider Demographics
NPI:1477800738
Name:HAMIDZADEH, FARID (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:FARID
Middle Name:
Last Name:HAMIDZADEH
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PARK PL
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-1229
Mailing Address - Country:US
Mailing Address - Phone:802-453-7700
Mailing Address - Fax:
Practice Address - Street 1:6 PARK PL
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443
Practice Address - Country:US
Practice Address - Phone:802-453-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 19736122300000X
VT016-0133850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist