Healthcare Provider Details

I. General information

NPI: 1831025048
Provider Name (Legal Business Name): SHIRIN MAALHAGH FARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24521 FORD RD
DEARBORN MI
48128-1131
US

IV. Provider business mailing address

45989 TOURNAMENT DR
NORTHVILLE MI
48168-9633
US

V. Phone/Fax

Practice location:
  • Phone: 313-278-6333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901603040
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: