Provider Demographics
NPI:1588493571
Name:BHUIYAN, FAHRIN N (DMD)
Entity type:Individual
Prefix:
First Name:FAHRIN
Middle Name:N
Last Name:BHUIYAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7613 HAVEN AVE APT F
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1763
Mailing Address - Country:US
Mailing Address - Phone:909-286-0006
Mailing Address - Fax:
Practice Address - Street 1:8627 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-3501
Practice Address - Country:US
Practice Address - Phone:323-531-7741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS110256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist