Healthcare Provider Details

I. General information

NPI: 1033985668
Provider Name (Legal Business Name): FARZAD MORADI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 NE 10TH AVE
PAYETTE ID
83661-5422
US

IV. Provider business mailing address

1501 NE 10TH AVE
PAYETTE ID
83661-5422
US

V. Phone/Fax

Practice location:
  • Phone: 208-642-9379
  • Fax: 208-642-5004
Mailing address:
  • Phone: 208-642-9379
  • Fax: 208-642-5004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7371794
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: