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General NPI Number Information
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NPI Number | 1275848012
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Entity Type | Organization
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Legal Business Name | HIRAM CENTER FOR FAMILY DENTISTRY
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Dates
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Enumeration Date | 08/17/2010
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | 4374 ATLANTA HWY STE 109
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City | HIRAM
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State | GA
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Zip | 30141-1849
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Country | US
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Telephone | 770-505-9898
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Fax | 404-393-1154
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Provider Business Mailing Address
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Address Line | 4374 ATLANTA HWY STE 109
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City | HIRAM
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State | GA
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Zip | 30141-1849
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Country | US
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Telephone | 770-505-9898
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Fax | 404-393-1154
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. FARHAD FRANK FARAHANINIA
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Credential | D.M.D
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Telephone | 404-723-8396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN013699
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN013474
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License Number State | GA
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