Provider Demographics
NPI:1760471148
Name:HOOSHI, FARZAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARZAD
Middle Name:
Last Name:HOOSHI
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 1:4304 MAIN STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-888-2328
Mailing Address - Fax:718-888-9983
Practice Address - Street 1:4304 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4742
Practice Address - Country:US
Practice Address - Phone:718-888-2328
Practice Address - Fax:718-888-9983
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0485681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02092051Medicaid
NY02526396Medicaid