Provider Demographics
NPI:1104951771
Name:FIROUZIAN, FARZAD (DDS FAGD)
Entity type:Individual
Prefix:DR
First Name:FARZAD
Middle Name:
Last Name:FIROUZIAN
Suffix:
Gender:M
Credentials:DDS FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E CAMPUS VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5691
Mailing Address - Country:US
Mailing Address - Phone:614-848-5001
Mailing Address - Fax:614-848-5003
Practice Address - Street 1:1 E CAMPUS VIEW BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5691
Practice Address - Country:US
Practice Address - Phone:614-848-5001
Practice Address - Fax:614-848-5003
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH194151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice