Individual
FARBOD BAGHAEI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
255 MASON AVE, STATEN ISLAND, NY 10305-3416
(718) 987-6543
Mailing address
255 MASON AVE, STATEN ISLAND, NY 10305-3416
(718) 987-6543
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
063804-01
NY
1223G0001X
General Practice Dentistry
38240
TX
Other
Enumeration date
04/08/2021
Last updated
07/11/2024
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