Provider Demographics
NPI:1881733251
Name:FARAHANI, HAMID (DDS)
Entity type:Individual
Prefix:DR
First Name:HAMID
Middle Name:
Last Name:FARAHANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-7100
Mailing Address - Country:US
Mailing Address - Phone:972-414-8800
Mailing Address - Fax:972-526-5833
Practice Address - Street 1:1922 BELT LINE RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-7100
Practice Address - Country:US
Practice Address - Phone:972-414-8800
Practice Address - Fax:972-526-5833
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217141223G0001X
TX21724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1777492-01Medicaid
TX177749202Medicaid