Provider Demographics
NPI:1316808272
Name:FARNOOSH LAK, DMD, DENTAL CORP
Entity type:Organization
Organization Name:FARNOOSH LAK, DMD, DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FARNOOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:925-837-6318
Mailing Address - Street 1:520 LA GONDA WAY STE 204
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-1741
Mailing Address - Country:US
Mailing Address - Phone:925-837-6318
Mailing Address - Fax:925-837-6318
Practice Address - Street 1:520 LA GONDA WAY STE 204
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-1741
Practice Address - Country:US
Practice Address - Phone:925-837-6318
Practice Address - Fax:925-837-6318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty