Provider Demographics
NPI:1497465629
Name:PHARAR FOUNDATION
Entity Type:Organization
Organization Name:PHARAR FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHARAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:909-223-2991
Mailing Address - Street 1:1781 VILLAGE CENTER CIR STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-0573
Mailing Address - Country:US
Mailing Address - Phone:702-445-7075
Mailing Address - Fax:702-834-3332
Practice Address - Street 1:1781 VILLAGE CENTER CIR STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-0573
Practice Address - Country:US
Practice Address - Phone:702-445-7075
Practice Address - Fax:702-834-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental