Individual
KOOSHA FARNOOSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1286 STATE ROUTE 3 S STE 7, CROFTON, MD 21114-1340
(410) 721-7629
Mailing address
1286 STATE ROUTE 3 N #7, CROFTON, MD 21114
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
15963
MD
Other
Enumeration date
07/17/2015
Last updated
07/17/2015
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