Provider Demographics
NPI:1386623841
Name:ATHARI, FARSHAD (DDS)
Entity type:Individual
Prefix:DR
First Name:FARSHAD
Middle Name:
Last Name:ATHARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9530 S EASTERN AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-8032
Mailing Address - Country:US
Mailing Address - Phone:702-450-3371
Mailing Address - Fax:702-633-6079
Practice Address - Street 1:9530 S EASTERN AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-8032
Practice Address - Country:US
Practice Address - Phone:702-450-3371
Practice Address - Fax:702-633-6079
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5081122300000X
NV4826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist