Individual
DR. KENNY FARIVARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
8041 S 83RD AVE, LA VISTA, NE 68128-2490
(402) 884-1174
Mailing address
8041 S 83RD AVE, LA VISTA, NE 68128-2490
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7034
NE
Other
Enumeration date
06/19/2012
Last updated
06/19/2012
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