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DR. TIRBOD TODD FATTAHI M.D. DDS NPI 1093780603


NPI Information

NPI: 1093780603
Provider Name: DR. TIRBOD TODD FATTAHI, M.D. , DDS
Classification: Oral & Maxillofacial Surgery - 204E00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
655 W 8TH ST
UFJP ORAL SURGERY
JACKSONVILLE, FL
ZIP 32209
Phone: (904) 244-3901
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DR. Tirbod Todd Fattahi, M.D. , DDS is an oral maxillofacial surgery in Jacksonville, FL with 25 years of experience. The provider is oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. DR. Tirbod Todd Fattahi, M.D. , DDS NPI is 1093780603. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE
Graduation Year:1999

The provider's business location address is:

655 W 8TH ST
UFJP ORAL SURGERY
JACKSONVILLE, FL
ZIP 32209-511
Phone: (904) 244-3901
Fax: (904) 244-3218

The NPI 1093780603 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/18/2006 and was last updated on 4/29/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1122300000XDentistDTP368FLORIDANo
2204E00000XOral & Maxillofacial SurgeryME85119FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10752941-00MEDICAIDFLORIDA
2000947339CMEDICAIDGEORGIA
3H66373MEDICARE UPINFLORIDA
42644371-00MEDICAIDFLORIDA
5190010416MEDICARE PINFLORIDA
617581ZMEDICARE PINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.