Fattahi, Tirbod Todd

Fattahi, Tirbod Todd is an individual health care provider with primary practice located at 655 W 8Th St Ufjp Oral Surgery, Jacksonville FL 32209-6511. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery, Dental Providers / Dentist. Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery is his primary health care specialty. Fattahi, Tirbod Todd can be contacted via phone (904) 244-3901.

Contact Information

Primary practice address
655 W 8Th St Ufjp Oral Surgery Jacksonville FL 32209-6511
Phone: (904) 244-3901
Fax: (904) 244-3218
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X ME85119 Florida
Dental Providers / Dentist 122300000X DTP368 Florida

Profile Details

NPI number 1093780603
LBN Legal business name Fattahi, Tirbod Todd
Credentials M.D. , DDS
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 18th, 2006
Last updated Apr 29th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093780603 NPPES
Florida MEDICAID 2644371-00
Florida MEDICAID 0752941-00
Florida MEDICAID 000947339C

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