Provider Demographics
NPI:1770590580
Name:ERFAN, FARROKH (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:FARROKH
Middle Name:
Last Name:ERFAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 N FREDERICK AVE
Mailing Address - Street 2:UNIT 100
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2461
Mailing Address - Country:US
Mailing Address - Phone:301-921-0048
Mailing Address - Fax:301-963-1253
Practice Address - Street 1:438 N FREDERICK AVE
Practice Address - Street 2:UNIT 100
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2461
Practice Address - Country:US
Practice Address - Phone:301-921-0048
Practice Address - Fax:301-963-1253
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106301223P0221X
VA04010083691223P0221X
DCDEN51151223P0221X
CA544921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD022751000Medicaid