Provider Demographics
NPI:1285764621
Name:AKHTARI, FARHAD (DMD)
Entity type:Individual
Prefix:DR
First Name:FARHAD
Middle Name:
Last Name:AKHTARI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 DAVID CT
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1076
Mailing Address - Country:US
Mailing Address - Phone:401-463-7676
Mailing Address - Fax:401-463-8108
Practice Address - Street 1:1 LAMBERT LIND HWY
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1160
Practice Address - Country:US
Practice Address - Phone:401-463-7676
Practice Address - Fax:401-463-8108
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI.22841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9008148OtherMEDICAL ASSISTANCE
RI8148-3OtherBLUE CROSS