Provider Demographics
NPI:1588856199
Name:ESMAEILI & FARHIDPOUR, DDS, INC.
Entity Type:Organization
Organization Name:ESMAEILI & FARHIDPOUR, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAJID
Authorized Official - Middle Name:
Authorized Official - Last Name:ESMAEILI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-902-1212
Mailing Address - Street 1:13768 ROSWELL AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1401
Mailing Address - Country:US
Mailing Address - Phone:909-902-1212
Mailing Address - Fax:909-902-1213
Practice Address - Street 1:13768 ROSWELL AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1401
Practice Address - Country:US
Practice Address - Phone:909-902-1212
Practice Address - Fax:909-902-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty