Provider Demographics
NPI:1689040008
Name:FARZIN, MATTHEW CLIFTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CLIFTON
Last Name:FARZIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SHAWAN RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1373
Mailing Address - Country:US
Mailing Address - Phone:443-275-9641
Mailing Address - Fax:
Practice Address - Street 1:5 SHAWAN RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-1373
Practice Address - Country:US
Practice Address - Phone:443-275-9641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16047122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist