Provider Demographics
NPI:1013051937
Name:FARHOUMAND, FOAD (DDS PC)
Entity Type:Individual
Prefix:
First Name:FOAD
Middle Name:
Last Name:FARHOUMAND
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 JACKSON TAVERN WAY
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-1153
Mailing Address - Country:US
Mailing Address - Phone:703-864-3993
Mailing Address - Fax:
Practice Address - Street 1:8150 LEESBURG PIKE
Practice Address - Street 2:SUITE 920
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-7715
Practice Address - Country:US
Practice Address - Phone:703-821-1072
Practice Address - Fax:703-821-0692
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010069981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice