MEDICARE: SOGAND FARTASH DDS PLLC

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	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1326719873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOGAND FARTASH DDS PLLC

Provider Business Mailing Address
First Line	:	3627 S PENNSYLVANIA ST
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-3753
Country	:	US
Telephone Number	:	303-781-0624
Fax Number	:

Provider Business Practice Location Address
First Line	:	3627 S PENNSYLVANIA ST
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-3753
Country	:	US
Telephone Number	:	303-781-0624
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SOGAND FARTASH NAINI
Credential	:	DDS
Telephone Number	:	303-781-0624

Provider Enumeration Date	:	09/24/2021
Last Update Date	:	09/24/2021

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