Provider Demographics
NPI:1457834467
Name:FARHAD MAZI, DDS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FARHAD MAZI, DDS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-242-7753
Mailing Address - Street 1:19190 US HIGHWAY 18 STE A
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2558
Mailing Address - Country:US
Mailing Address - Phone:760-242-7753
Mailing Address - Fax:760-946-1122
Practice Address - Street 1:7772 WARNER AVE STE 105
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-8028
Practice Address - Country:US
Practice Address - Phone:714-375-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FARHAD MAZI, DDS, A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental