MEDICARE: DR. FARSHAD 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	5081	AZ
2	122300000X	Dentist	4826	NV

General Provider Information

NPI Number	:	1386623841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARSHAD ATHARI DDS

Provider Business Mailing Address
First Line	:	9530 S EASTERN AVE
Second Line	:	SUITE 160
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-8032
Country	:	US
Telephone Number	:	702-450-3371
Fax Number	:	702-633-6079

Provider Business Practice Location Address
First Line	:	9530 S EASTERN AVE
Second Line	:	SUITE 160
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-8032
Country	:	US
Telephone Number	:	702-450-3371
Fax Number	:	702-633-6079

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	08/05/2013

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