Provider Demographics
NPI:1528439403
Name:FARHANGPOUR, AMIR (DDS)
Entity type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:FARHANGPOUR
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 1:989375 NEBRESKA MED CENTER
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-9375
Mailing Address - Country:US
Mailing Address - Phone:402-559-6000
Mailing Address - Fax:402-559-9307
Practice Address - Street 1:989375 NEBRESKA MED CENTER
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-9375
Practice Address - Country:US
Practice Address - Phone:402-559-6000
Practice Address - Fax:402-559-9307
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-17
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN13984OtherFDH