Provider Demographics
NPI:1992951024
Name:FARAHANI, ZAHRA (DMD)
Entity type:Individual
Prefix:
First Name:ZAHRA
Middle Name:
Last Name:FARAHANI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:Z
Other - Last Name:FARAHANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:12186 HIGHWAY 92
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-5105
Mailing Address - Country:US
Mailing Address - Phone:678-238-0202
Mailing Address - Fax:678-238-0204
Practice Address - Street 1:12186 HIGHWAY 92
Practice Address - Street 2:SUITE 109
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-5105
Practice Address - Country:US
Practice Address - Phone:678-238-0202
Practice Address - Fax:678-238-0204
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0120421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00898719BMedicaid
201535400OtherTIN