Provider Demographics
NPI:1043059983
Name:FAR, NISA (DDS)
Entity type:Individual
Prefix:
First Name:NISA
Middle Name:
Last Name:FAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12430 VENTANA MESA CT
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9145
Mailing Address - Country:US
Mailing Address - Phone:720-878-3335
Mailing Address - Fax:
Practice Address - Street 1:1790 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-1934
Practice Address - Country:US
Practice Address - Phone:303-659-1064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00205965122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist