Provider Demographics
NPI:1073528865
Name:FARA SALEHI DDS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FARA SALEHI DDS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-342-2000
Mailing Address - Street 1:18740 VENTURA BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-342-2000
Mailing Address - Fax:818-708-8000
Practice Address - Street 1:18740 VENTURA BLVD
Practice Address - Street 2:STE 105
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:818-342-2000
Practice Address - Fax:818-708-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty