Provider Demographics
NPI:1427251560
Name:MEHRDAD, FARZIN (DDS)
Entity type:Individual
Prefix:DR
First Name:FARZIN
Middle Name:
Last Name:MEHRDAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 BAKER ST
Mailing Address - Street 2:SUITE# 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:SUITE# 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
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA471271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice