Provider Demographics
NPI:1477966067
Name:FROOZ FATOORACHI,DDS,APC
Entity Type:Organization
Organization Name:FROOZ FATOORACHI,DDS,APC
Other - Org Name:ACCESS CHILDREN'S DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEJANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUITRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-732-3100
Mailing Address - Street 1:1944 VIA CTR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6056
Mailing Address - Country:US
Mailing Address - Phone:760-732-3100
Mailing Address - Fax:
Practice Address - Street 1:1944 VIA CTR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6056
Practice Address - Country:US
Practice Address - Phone:760-732-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:33-778296
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-11
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912051418Medicaid
CAG92986OtherMEDICAL
CA1427102094OtherPROVIDER NPI