Provider Demographics
NPI:1518066422
Name:FARSIO, FARIBORZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARIBORZ
Middle Name:
Last Name:FARSIO
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 1:18800 MAIN ST
Mailing Address - Street 2:STE 209
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1718
Mailing Address - Country:US
Mailing Address - Phone:714-847-3513
Mailing Address - Fax:714-375-2199
Practice Address - Street 1:31 E MACARTHUR CRES
Practice Address - Street 2:SUITE 109
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-5932
Practice Address - Country:US
Practice Address - Phone:714-549-1248
Practice Address - Fax:714-549-1246
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460571223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics