Healthcare Provider Details

I. General information

NPI: 1013123777
Provider Name (Legal Business Name): FARID HANACHI DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1377A E GARRISON BLVD
GASTONIA NC
28054-5127
US

IV. Provider business mailing address

1377A E GARRISON BLVD
GASTONIA NC
28054-5127
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-9889
  • Fax: 704-864-2966
Mailing address:
  • Phone: 704-865-9889
  • Fax: 704-864-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6116
License Number StateNC

VIII. Authorized Official

Name: DR. FARID HANACHI
Title or Position: ORTHODONTIST
Credential: DDS PA
Phone: 704-865-9889