Individual
SAMIRA FAROKH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D
Contact information
Practice address
3896 N MLK BLVD, NORTH LAS VEGAS, NV 89032-6603
(702) 395-5437
(702) 933-0190
Mailing address
2109 BACHELOR CT, LAS VEGAS, NV 89128-7620
(702) 234-8557
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
6328
NV
1223P0221X
Pediatric Dentistry
Primary
S6-168
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001719087
DRIVERS LICENSE
NV
Enumeration date
12/21/2012
Last updated
06/17/2019
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