Provider Demographics
NPI:1376836486
Name:ALLEN S FARI DDS, INC
Entity Type:Organization
Organization Name:ALLEN S FARI DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:FARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-735-2111
Mailing Address - Street 1:914 WASHBURN AVE
Mailing Address - Street 2:STE #5
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-4362
Mailing Address - Country:US
Mailing Address - Phone:951-735-2111
Mailing Address - Fax:951-735-2350
Practice Address - Street 1:914 WASHBURN AVE
Practice Address - Street 2:STE #5
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-4362
Practice Address - Country:US
Practice Address - Phone:951-735-2111
Practice Address - Fax:951-735-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty