Provider Demographics
NPI:1437557360
Name:SALEHI, FARA (DDS)
Entity Type:Individual
Prefix:
First Name:FARA
Middle Name:
Last Name:SALEHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18740 VENTURA BLVD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6302
Mailing Address - Country:US
Mailing Address - Phone:818-342-2000
Mailing Address - Fax:818-708-8000
Practice Address - Street 1:18740 VENTURA BLVD
Practice Address - Street 2:SUITE #105
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6302
Practice Address - Country:US
Practice Address - Phone:818-342-2000
Practice Address - Fax:818-708-8000
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36608122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist