Provider Demographics
NPI:1821021916
Name:KESHMIRI, FARZANEH (DDS, PA)
Entity Type:Individual
Prefix:
First Name:FARZANEH
Middle Name:
Last Name:KESHMIRI
Suffix:
Gender:F
Credentials:DDS, PA
Other - Prefix:
Other - First Name:FARZANEH
Other - Middle Name:
Other - Last Name:KESHMIRI-SANCHEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, PA
Mailing Address - Street 1:5641 POPLAR TENT RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7533
Mailing Address - Country:US
Mailing Address - Phone:704-793-4211
Mailing Address - Fax:704-793-4210
Practice Address - Street 1:5641 POPLAR TENT RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7533
Practice Address - Country:US
Practice Address - Phone:704-793-4211
Practice Address - Fax:704-793-4210
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903310Medicaid