Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 19247 | TX |
NPI | 1083741268 |
---|---|
Provider Name | Dr. Farhad Eslamboltchi |
First Address | Arlington, TX 76015 |
Second Address | Arlington, TX 76015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 08/07/2007 |