Provider Demographics
NPI:1073958286
Name:FARID, AHMED (DMD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:FARID
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 CALLE CANELA
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-4803
Mailing Address - Country:US
Mailing Address - Phone:310-880-7057
Mailing Address - Fax:
Practice Address - Street 1:337 CALLE CANELA
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-4803
Practice Address - Country:US
Practice Address - Phone:310-880-7057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1065881223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics