MEDICARE: DR. FAREED ENZO IGHANI 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	36426	TX

General Provider Information

NPI Number	:	1134739451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAREED ENZO IGHANI DDS

Provider Business Mailing Address
First Line	:	2469 FOREST PARK BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1731
Country	:	US
Telephone Number	:	469-766-0906
Fax Number	:

Provider Business Practice Location Address
First Line	:	2469 FOREST PARK BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1731
Country	:	US
Telephone Number	:	817-924-6211
Fax Number	:	817-924-6212

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

Provider Enumeration Date	:	08/01/2020
Last Update Date	:	02/14/2025

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