Provider Demographics
NPI:1790127744
Name:ROUHANI, FARSHAD (DMD)
Entity Type:Individual
Prefix:
First Name:FARSHAD
Middle Name:
Last Name:ROUHANI
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 1:10401 E MCDOWELL MOUNTAIN RANCH RD STE 130
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-7525
Mailing Address - Country:US
Mailing Address - Phone:480-508-6501
Mailing Address - Fax:480-758-5798
Practice Address - Street 1:10401 E MCDOWELL MOUNTAIN RANCH RD STE 130
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255
Practice Address - Country:US
Practice Address - Phone:480-508-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7134 - 15122300000X
AZD008764122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist