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General NPI Number Information
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NPI Number | 1770220402
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Entity Type | Individual
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Provider Name | FARHAD KEVIN BAGHAIE DDS
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Gender | Male
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Dates
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Enumeration Date | 05/14/2022
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 527 TUSKEGEE AIRMAN BLVD. BLDG 500
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City | SHEPPARD AFB
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State | TX
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Zip | 76311
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Country | US
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Telephone | 940-676-1914
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 SANTA FE ST APT 808
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City | WICHITA FALLS
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State | TX
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Zip | 76309-3454
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Country | US
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Telephone | 248-719-6660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | MI
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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 | 2901601356
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License Number State | MI
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