Provider Demographics
NPI:1104109289
Name:FARHOUMAND, BITA (DDS)
Entity type:Individual
Prefix:DR
First Name:BITA
Middle Name:
Last Name:FARHOUMAND
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 1:2487 WELLSPRING ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-5605
Mailing Address - Country:US
Mailing Address - Phone:703-981-3185
Mailing Address - Fax:
Practice Address - Street 1:2487 WELLSPRING ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-5605
Practice Address - Country:US
Practice Address - Phone:703-981-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412973122300000X
CADDS612011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist