Provider Demographics
NPI:1932326170
Name:FARAHMAND, SASAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SASAN
Middle Name:
Last Name:FARAHMAND
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 1:208 S RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5304
Mailing Address - Country:US
Mailing Address - Phone:702-363-0444
Mailing Address - Fax:702-363-4136
Practice Address - Street 1:208 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5304
Practice Address - Country:US
Practice Address - Phone:702-363-0444
Practice Address - Fax:702-363-4136
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV44111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice