Provider Demographics
NPI:1407913577
Name:PARTOVI, FARHAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARHAD
Middle Name:
Last Name:PARTOVI
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 1:811 MEADOW CREEK CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5346
Mailing Address - Country:US
Mailing Address - Phone:925-366-9099
Mailing Address - Fax:
Practice Address - Street 1:800 C STREET
Practice Address - Street 2:ANTIOCH DENTAL GROUP
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-1719
Practice Address - Country:US
Practice Address - Phone:925-757-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA415101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB41510Medicaid