Provider Demographics
NPI:1013417443
Name:M.G. FARZIN, D.D.S., INC.
Entity Type:Organization
Organization Name:M.G. FARZIN, D.D.S., INC.
Other - Org Name:FIRST STREET DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAHIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:FARZIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-546-5579
Mailing Address - Street 1:2010 EAST FIRST STREET
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:714-546-5579
Mailing Address - Fax:714-542-8785
Practice Address - Street 1:2010 EAST FIRST STREET
Practice Address - Street 2:SUITE 230
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:714-546-5579
Practice Address - Fax:714-542-2785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43754122300000X
CA52980122300000X
CA490501223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty