NPI Details
DR. Tirbod Todd Fattahi, M.D. , DDS is an oral maxillofacial surgery in Jacksonville, FL with 27 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 following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.
- Melanoma (skin cancer) excision (HCPCS:NAN03)
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 Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 122300000X | Dentist | | DTP368 | FLORIDA | No |
| 2 | 204E00000X | Oral & Maxillofacial Surgery | | ME85119 | FLORIDA | Yes |
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 Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 0752941-00 | MEDICAID | FLORIDA | |
| 2 | 000947339C | MEDICAID | GEORGIA | |
| 3 | H66373 | MEDICARE UPIN | FLORIDA | |
| 4 | 2644371-00 | MEDICAID | FLORIDA | |
| 5 | 190010416 | MEDICARE PIN | FLORIDA | |
| 6 | 17581Z | MEDICARE PIN | FLORIDA | |
