Provider Demographics
NPI:1851364012
Name:FEREYDOUNI, AMIR (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:
Last Name:FEREYDOUNI
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 1:8199 SOUTHPARK LN
Mailing Address - Street 2:150
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5667
Mailing Address - Country:US
Mailing Address - Phone:303-738-8828
Mailing Address - Fax:303-738-8823
Practice Address - Street 1:8199 SOUTHPARK LN
Practice Address - Street 2:150
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5667
Practice Address - Country:US
Practice Address - Phone:303-738-8828
Practice Address - Fax:303-738-8823
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90323840Medicaid