Healthcare Provider Details

I. General information

NPI: 1770708224
Provider Name (Legal Business Name): FARAH POUSTCHI-AMIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 TAMPA RD
PALM HARBOR FL
34684-3312
US

IV. Provider business mailing address

2707 TAMPA RD
PALM HARBOR FL
34684-3312
US

V. Phone/Fax

Practice location:
  • Phone: 727-785-6521
  • Fax: 727-785-6237
Mailing address:
  • Phone: 727-785-6521
  • Fax: 727-785-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN12040
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: