Provider Demographics
NPI:1619100286
Name:FARMINGTON DENTAL PLLC
Entity Type:Organization
Organization Name:FARMINGTON DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAALHAGH-FARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:248-553-9393
Mailing Address - Street 1:34405 W 12 MILE RD
Mailing Address - Street 2:SUITE 187
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3391
Mailing Address - Country:US
Mailing Address - Phone:248-553-9393
Mailing Address - Fax:
Practice Address - Street 1:34405 W 12 MILE RD
Practice Address - Street 2:SUITE 187
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3391
Practice Address - Country:US
Practice Address - Phone:248-553-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0171041223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty