Provider Demographics
NPI:1811000698
Name:MOGHADASI, FARID (DMD)
Entity Type:Individual
Prefix:DR
First Name:FARID
Middle Name:
Last Name:MOGHADASI
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 1:5608 US HIGHWAY 98 NORTH
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809
Mailing Address - Country:US
Mailing Address - Phone:863-858-7600
Mailing Address - Fax:863-859-0408
Practice Address - Street 1:5608 US HIGHWAY 98 NORTH
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809
Practice Address - Country:US
Practice Address - Phone:863-858-7600
Practice Address - Fax:863-859-0408
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13330122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist