Provider Demographics
NPI:1063574762
Name:BASHTI, FARID (DMD)
Entity type:Individual
Prefix:
First Name:FARID
Middle Name:
Last Name:BASHTI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 W STEELE LN STE 1
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3553
Mailing Address - Country:US
Mailing Address - Phone:707-978-2296
Mailing Address - Fax:707-978-2667
Practice Address - Street 1:1175 W STEELE LN STE 1
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3553
Practice Address - Country:US
Practice Address - Phone:707-978-2296
Practice Address - Fax:707-978-2667
Is Sole Proprietor?:No
Enumeration Date:2006-12-16
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice