Provider Demographics
NPI:1154497949
Name:KANDAKLOO, FARHAD (DDS)
Entity Type:Individual
Prefix:
First Name:FARHAD
Middle Name:
Last Name:KANDAKLOO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CLAREMONT CREST CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1298
Mailing Address - Country:US
Mailing Address - Phone:925-208-1602
Mailing Address - Fax:
Practice Address - Street 1:1586 GATEWAY BLVD STE C1
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6911
Practice Address - Country:US
Practice Address - Phone:925-426-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-26
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41626122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist