Provider Demographics
NPI:1053539650
Name:ASSADERAGHI, FARSHID (DDS)
Entity type:Individual
Prefix:DR
First Name:FARSHID
Middle Name:
Last Name:ASSADERAGHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2711
Mailing Address - Country:US
Mailing Address - Phone:718-469-6077
Mailing Address - Fax:718-462-1785
Practice Address - Street 1:1025 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2711
Practice Address - Country:US
Practice Address - Phone:718-469-6077
Practice Address - Fax:718-462-1785
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0508771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02427127Medicaid