Provider Demographics
NPI:1548359649
Name:FARANAK GHALEHBAGHI PC
Entity type:Organization
Organization Name:FARANAK GHALEHBAGHI PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:MS
Authorized Official - First Name:FARANAK
Authorized Official - Middle Name:
Authorized Official - Last Name:GHALEHBAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-352-4121
Mailing Address - Street 1:10875 MAIN ST # 105
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-352-4121
Mailing Address - Fax:703-352-4122
Practice Address - Street 1:10875 MAIN ST # 105
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-352-4121
Practice Address - Fax:703-352-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA8254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty