Healthcare Provider Details

I. General information

NPI: 1063045847
Provider Name (Legal Business Name): FARINAZ SEPAHIFAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MAIN ST
PATERSON NJ
07503-2621
US

IV. Provider business mailing address

701 N STEPHENSON HWY APT 101
ROYAL OAK MI
48067-2147
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-2050
  • Fax:
Mailing address:
  • Phone: 909-638-6627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number30041
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: