Provider Demographics
NPI:1063571198
Name:TEBYANI, FARID (DDS)
Entity type:Individual
Prefix:DR
First Name:FARID
Middle Name:
Last Name:TEBYANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 WILLOW LN STE 208
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4988
Mailing Address - Country:US
Mailing Address - Phone:805-230-1900
Mailing Address - Fax:805-230-1912
Practice Address - Street 1:3180 WILLOW LN STE 208
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-4988
Practice Address - Country:US
Practice Address - Phone:805-230-1900
Practice Address - Fax:805-230-1912
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA534851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice