Provider Demographics
NPI:1134739451
Name:IGHANI, FAREED ENZO (DDS)
Entity type:Individual
Prefix:DR
First Name:FAREED
Middle Name:ENZO
Last Name:IGHANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:FARID
Other - Middle Name:
Other - Last Name:IGHANIHOSSEINABAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2469 FOREST PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1731
Mailing Address - Country:US
Mailing Address - Phone:469-766-0906
Mailing Address - Fax:
Practice Address - Street 1:2469 FOREST PARK BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1731
Practice Address - Country:US
Practice Address - Phone:817-924-6211
Practice Address - Fax:817-924-6212
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-01
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36426122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty