Provider Demographics
NPI:1982682951
Name:FARROKH, AARON REZA (DMD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:REZA
Last Name:FARROKH
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 1:9 AVONWOOD RD
Mailing Address - Street 2:BUILDING B
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2072
Mailing Address - Country:US
Mailing Address - Phone:860-284-4411
Mailing Address - Fax:
Practice Address - Street 1:9 AVONWOOD RD
Practice Address - Street 2:BUILDING B
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2072
Practice Address - Country:US
Practice Address - Phone:860-284-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0508271122300000X
CT0095761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist