Provider Demographics
NPI:1215382262
Name:AVANTI SPECIALTY PLLC
Entity type:Organization
Organization Name:AVANTI SPECIALTY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FARHOUMAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-625-6229
Mailing Address - Street 1:1500 CORNERSIDE BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:TYSONS CORNER
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2440
Mailing Address - Country:US
Mailing Address - Phone:703-625-6229
Mailing Address - Fax:703-821-0692
Practice Address - Street 1:1500 CORNERSIDE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:TYSONS CORNER
Practice Address - State:VA
Practice Address - Zip Code:22182-2440
Practice Address - Country:US
Practice Address - Phone:703-625-6229
Practice Address - Fax:703-821-0692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04380003111223D0004X, 1223S0112X
VA04014111831223E0200X
VA04010049981223G0001X
VA04014129731223P0300X
VA04014142381223P0700X
VA04014133941223X0400X
VA04014139551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty