Healthcare Provider Details

I. General information

NPI: 1083741268
Provider Name (Legal Business Name): FARHAD ESLAMBOLTCHI DMD MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FARHAD E BOLTCHI DMD MS

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W ARBROOK BLVD SUITE 360
ARLINGTON TX
76015
US

IV. Provider business mailing address

800 W ARBROOK BLVD SUITE 360
ARLINGTON TX
76015
US

V. Phone/Fax

Practice location:
  • Phone: 817-467-7731
  • Fax: 817-472-6393
Mailing address:
  • Phone: 817-467-7731
  • Fax: 817-472-6393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number19247
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: