MEDICARE: DR. FAROKH JIVEH 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	DN14120	FL

General Provider Information

NPI Number	:	1952501827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAROKH JIVEH DDS

Provider Business Mailing Address
First Line	:	11989 SOUTHERN BLVD
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-7619
Country	:	US
Telephone Number	:	561-798-9997
Fax Number	:	561-798-9395

Provider Business Practice Location Address
First Line	:	11989 SOUTHERN BLVD
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-7619
Country	:	US
Telephone Number	:	561-798-9997
Fax Number	:	561-798-9395

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

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	07/19/2007

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