Provider Demographics
NPI:1174688105
Name:FARSAKIAN, JOHN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:FARSAKIAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 AUBURN CT
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3618
Mailing Address - Country:US
Mailing Address - Phone:805-496-4133
Mailing Address - Fax:805-496-1185
Practice Address - Street 1:179 AUBURN CT
Practice Address - Street 2:SUITE 5
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3618
Practice Address - Country:US
Practice Address - Phone:805-496-4133
Practice Address - Fax:805-496-1185
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics