Provider Demographics
NPI:1497939508
Name:FARZAD SANI, DDS,PC
Entity Type:Organization
Organization Name:FARZAD SANI, DDS,PC
Other - Org Name:PEDIATRIC DENTISTRY OF GLENS FALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FARZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-798-9966
Mailing Address - Street 1:88 BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-798-9966
Mailing Address - Fax:518-798-0616
Practice Address - Street 1:88 BROAD STREET
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-798-9966
Practice Address - Fax:518-798-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000404001006OtherBLUE SHIELD
NY02410617Medicaid
NY1496306OtherUNITED CONCORDIA
0017845OtherDORAL DENTAL
NY10072379OtherCDPHP