Provider Demographics
NPI:1770101792
Name:TAGHIZADEH, FARSHAD (DMD)
Entity type:Individual
Prefix:DR
First Name:FARSHAD
Middle Name:
Last Name:TAGHIZADEH
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 1:5317 DITTANY CT
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-2826
Mailing Address - Country:US
Mailing Address - Phone:804-304-0391
Mailing Address - Fax:
Practice Address - Street 1:5317 DITTANY CT
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-2826
Practice Address - Country:US
Practice Address - Phone:804-304-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014169661223G0001X
FLDN257061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice