Individual
DR. FARHAD AZIZZADEH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
96 09 SPRINGFIELD BLVD, SUITE 206, QUEENS VILLAGE, NY 11429
(718) 470-7700
(718) 740-8005
Mailing address
96 09 SPRINGFIELD BLVD, SUITE 206, QUEENS VILLAGE, NY 11429
(718) 470-7700
(718) 740-8005
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
046904
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01925382
—
NY
Enumeration date
11/30/2005
Last updated
11/13/2014
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