Provider Demographics
NPI:1548783350
Name:FARHAN, MOHAMMAD SHAHID (DDS)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:SHAHID
Last Name:FARHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:SHAHID
Other - Middle Name:
Other - Last Name:FARHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:219 RICHARDSON ST APT 3310
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-4436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9007 TWO NOTCH RD STE B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5834
Practice Address - Country:US
Practice Address - Phone:803-212-0387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC108101223G0001X
SC9482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice