Provider Demographics
NPI:1386783108
Name:FARZIN, MATT G (DDS)
Entity type:Individual
Prefix:DR
First Name:MATT
Middle Name:G
Last Name:FARZIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:G
Other - Last Name:FARZIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2969 HARBOR BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3912
Mailing Address - Country:US
Mailing Address - Phone:714-437-1100
Mailing Address - Fax:714-437-1107
Practice Address - Street 1:2969 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3912
Practice Address - Country:US
Practice Address - Phone:714-437-1100
Practice Address - Fax:714-437-1107
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA535951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice