Provider Demographics
NPI:1376788919
Name:MASOUD FANAIAN DDS INC
Entity Type:Organization
Organization Name:MASOUD FANAIAN DDS INC
Other - Org Name:REEDLEY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MASOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:FANAIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-638-3611
Mailing Address - Street 1:1140 F ST
Mailing Address - Street 2:
Mailing Address - City:REEDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93654-3029
Mailing Address - Country:US
Mailing Address - Phone:559-638-3611
Mailing Address - Fax:
Practice Address - Street 1:1140 F ST
Practice Address - Street 2:
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654-3029
Practice Address - Country:US
Practice Address - Phone:559-638-3611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA421481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty