Provider Demographics
NPI:1124351374
Name:FARZIN MEHRDAD D.D.S. INC
Entity type:Organization
Organization Name:FARZIN MEHRDAD D.D.S. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FARZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHRDAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-545-9990
Mailing Address - Street 1:1175 BAKER ST
Mailing Address - Street 2:A-4
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4101
Mailing Address - Country:US
Mailing Address - Phone:714-545-9990
Mailing Address - Fax:714-545-7108
Practice Address - Street 1:1175 BAKER ST
Practice Address - Street 2:A-4
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4101
Practice Address - Country:US
Practice Address - Phone:714-545-9990
Practice Address - Fax:714-545-7108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47127261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental