Provider Demographics
NPI:1912051418
Name:FROOZ FATOORACHI,DDS,APC
Entity type:Organization
Organization Name:FROOZ FATOORACHI,DDS,APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FROOZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FATOORACHI-KORSAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-732-3100
Mailing Address - Street 1:1944 VIA CTR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6056
Mailing Address - Country:US
Mailing Address - Phone:760-732-3100
Mailing Address - Fax:760-732-3201
Practice Address - Street 1:1944 VIA CTR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6056
Practice Address - Country:US
Practice Address - Phone:760-732-3100
Practice Address - Fax:760-732-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA976622OtherUNITED CONCORDIA PROVIDER
CAG92986-01OtherDENTICAL GROUP #
CAB41405-01OtherHEALTHY FAMILY DELTA DENT