Provider Demographics
NPI:1548305170
Name:FARHOUMAND, FARSHAD (DDS PC)
Entity type:Individual
Prefix:DR
First Name:FARSHAD
Middle Name:
Last Name:FARHOUMAND
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 CORNERSIDE BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:TYSONS CORNER
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2433
Mailing Address - Country:US
Mailing Address - Phone:703-625-6229
Mailing Address - Fax:
Practice Address - Street 1:1500 CORNERSIDE BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:TYSONS CORNER
Practice Address - State:VA
Practice Address - Zip Code:22182-2433
Practice Address - Country:US
Practice Address - Phone:703-625-6229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010049981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice