=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013051937
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FOAD FARHOUMAND DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2007
-----------------------------------------------------
Last Update Date | 04/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8150 LEESBURG PIKE STE 920
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22182-2714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-636-2442
-----------------------------------------------------
Fax | 703-636-2440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8150 LEESBURG PIKE STE 920
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22182-2714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-636-2442
-----------------------------------------------------
Fax | 703-636-2440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 401006998
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 0401006998
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 401006998
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------