Provider Demographics
NPI:1669627113
Name:AVALON DENTAL LLC
Entity type:Organization
Organization Name:AVALON DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:PARHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FARHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:267-312-3184
Mailing Address - Street 1:6 LARCH AVE
Mailing Address - Street 2:UNIT 402
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-2300
Mailing Address - Country:US
Mailing Address - Phone:302-999-8822
Mailing Address - Fax:
Practice Address - Street 1:6 LARCH AVE
Practice Address - Street 2:UNIT 402
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-2300
Practice Address - Country:US
Practice Address - Phone:302-999-8822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00012001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty