Provider Demographics
NPI:1780389486
Name:FARHADI, ALI SINA
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:SINA
Last Name:FARHADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 TIMBERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6751
Mailing Address - Country:US
Mailing Address - Phone:314-766-2747
Mailing Address - Fax:
Practice Address - Street 1:86TH MEDICAL GROUP / RAMSTEIN AIR BASE UNIT 3215 APO AE
Practice Address - Street 2:
Practice Address - City:RAMSTEIN GEMEINDE RAMSTEIN-MIESENBACH
Practice Address - State:GERMANY
Practice Address - Zip Code:09094
Practice Address - Country:DE
Practice Address - Phone:496-371-4062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI29016018281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program