MEDICARE: DR. FARNAZ ATHARI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5629	NV
2	122300000X	Dentist	27586	TX
3	122300000X	Dentist	56275	CA

General Provider Information

NPI Number	:	1043498983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARNAZ ATHARI DDS

Provider Business Mailing Address
First Line	:	3701 W NORTHWEST HWY STE 306
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4962
Country	:	US
Telephone Number	:	702-275-9460
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 W NORTHWEST HWY STE 306
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4962
Country	:	US
Telephone Number	:	702-275-9460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	02/18/2015

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