Provider Demographics
NPI:1386731305
Name:FARZAD FIROUZIAN DDS PA
Entity type:Organization
Organization Name:FARZAD FIROUZIAN DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FARZAD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FIROUZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MA, FAGD
Authorized Official - Phone:614-848-5001
Mailing Address - Street 1:1 EAST CAMPUS VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH194151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty