Provider Demographics
NPI:1699567222
Name:FARTASH FARKHONDEHKISH DDS MS
Entity type:Organization
Organization Name:FARTASH FARKHONDEHKISH DDS MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTISIT
Authorized Official - Prefix:
Authorized Official - First Name:FARTASH
Authorized Official - Middle Name:
Authorized Official - Last Name:FARKHONDEHKISH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:949-770-0548
Mailing Address - Street 1:25283 CABOT RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5509
Mailing Address - Country:US
Mailing Address - Phone:949-770-0548
Mailing Address - Fax:949-770-7262
Practice Address - Street 1:25283 CABOT RD STE 110
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5509
Practice Address - Country:US
Practice Address - Phone:949-770-0548
Practice Address - Fax:949-770-7262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty