Provider Demographics
NPI:1316281447
Name:FARWAHA, JYOTI (DMD)
Entity type:Individual
Prefix:DR
First Name:JYOTI
Middle Name:
Last Name:FARWAHA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 NELSON RISING LN
Mailing Address - Street 2:UNIT 1005
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2292
Mailing Address - Country:US
Mailing Address - Phone:908-229-0661
Mailing Address - Fax:
Practice Address - Street 1:525 NELSON RISING LN
Practice Address - Street 2:UNIT 1005
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2292
Practice Address - Country:US
Practice Address - Phone:908-229-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA620381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice