Provider Demographics
NPI:1013684711
Name:HASSAN HAGHIGHI FARD, NASRIN
Entity type:Individual
Prefix:
First Name:NASRIN
Middle Name:
Last Name:HASSAN HAGHIGHI FARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 E BLACKLIDGE DR APT 1021
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2702
Mailing Address - Country:US
Mailing Address - Phone:310-318-4588
Mailing Address - Fax:
Practice Address - Street 1:1810 E BLACKLIDGE DR APT 1021
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2702
Practice Address - Country:US
Practice Address - Phone:310-318-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0111591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice