Provider Demographics
NPI:1922153121
Name:SOLEIMANI FARNAD, MAHKAMEH (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MAHKAMEH
Middle Name:
Last Name:SOLEIMANI FARNAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:MAHKAMEH
Other - Middle Name:
Other - Last Name:SOLEIMANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2840 HYLANE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098
Mailing Address - Country:US
Mailing Address - Phone:248-642-7016
Mailing Address - Fax:
Practice Address - Street 1:7743 GRAND RIVER AVE
Practice Address - Street 2:STE 202
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114
Practice Address - Country:US
Practice Address - Phone:810-222-9030
Practice Address - Fax:810-229-7361
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019489122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist