Provider Demographics
NPI:1558953653
Name:FARBOD DENTAL CORPORATION
Entity Type:Organization
Organization Name:FARBOD DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARBOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-435-3185
Mailing Address - Street 1:1777 M 28 E
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9525
Mailing Address - Country:US
Mailing Address - Phone:906-236-0147
Mailing Address - Fax:
Practice Address - Street 1:120 C AVE STE 150
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1990
Practice Address - Country:US
Practice Address - Phone:619-435-3185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental