Provider Demographics
NPI:1558986307
Name:FARNAZ AMINI DENTAL CORP.
Entity Type:Organization
Organization Name:FARNAZ AMINI DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-547-4444
Mailing Address - Street 1:2001 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2322
Mailing Address - Country:US
Mailing Address - Phone:714-547-4444
Mailing Address - Fax:
Practice Address - Street 1:2001 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2322
Practice Address - Country:US
Practice Address - Phone:714-547-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851724629Medicaid