Provider Demographics
NPI:1215090204
Name:MIRIAN, FARNAZ (DDS)
Entity type:Individual
Prefix:DR
First Name:FARNAZ
Middle Name:
Last Name:MIRIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DOGWOOD TER APT B
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8634
Mailing Address - Country:US
Mailing Address - Phone:910-215-0514
Mailing Address - Fax:910-997-8336
Practice Address - Street 1:127 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-3567
Practice Address - Country:US
Practice Address - Phone:910-417-4937
Practice Address - Fax:910-997-8336
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist