Provider Demographics
NPI:1770708224
Name:POUSTCHI-AMIN, FARAH (DDS)
Entity type:Individual
Prefix:MRS
First Name:FARAH
Middle Name:
Last Name:POUSTCHI-AMIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 TAMPA RD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3312
Mailing Address - Country:US
Mailing Address - Phone:727-785-6521
Mailing Address - Fax:727-785-6237
Practice Address - Street 1:2707 TAMPA RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3312
Practice Address - Country:US
Practice Address - Phone:727-785-6521
Practice Address - Fax:727-785-6237
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN120401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry