Provider Demographics
NPI:1235287335
Name:MATIAN, FARIBORZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARIBORZ
Middle Name:
Last Name:MATIAN
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 1:19900 VENTURA BLVD
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2645
Mailing Address - Country:US
Mailing Address - Phone:818-914-7484
Mailing Address - Fax:818-914-7489
Practice Address - Street 1:19900 VENTURA BLVD.,
Practice Address - Street 2:SUITE # 200
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-914-7484
Practice Address - Fax:818-914-7489
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA402721223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics