Provider Demographics
NPI:1508595661
Name:FARHADIAN, ARASH (DMD)
Entity Type:Individual
Prefix:
First Name:ARASH
Middle Name:
Last Name:FARHADIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208-908 CLARKE ROAD
Mailing Address - Street 2:
Mailing Address - City:PORT MOODY
Mailing Address - State:BRITISH COLUMBIA
Mailing Address - Zip Code:V3H 1L8
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 WEST CHARLESTON BOULEVARD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-774-2690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7640TU1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice