Provider Demographics
NPI:1821015751
Name:IRANPOUR- BOROUJENI, FARNAZ
Entity Type:Individual
Prefix:
First Name:FARNAZ
Middle Name:
Last Name:IRANPOUR- BOROUJENI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9482 HUNTERS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6660
Mailing Address - Country:US
Mailing Address - Phone:513-407-9005
Mailing Address - Fax:
Practice Address - Street 1:1041 OLD US-52
Practice Address - Street 2:NEW RICHMMOND DENTAL ASSOCIATES
Practice Address - City:NEW RICHMOND
Practice Address - State:OH
Practice Address - Zip Code:45157
Practice Address - Country:US
Practice Address - Phone:513-553-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND120481223G0001X
OH30-0220551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2563597Medicaid