Provider Demographics
NPI:1619161361
Name:YAZDANI, FARZAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARZAD
Middle Name:
Last Name:YAZDANI
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 1:31097 ROSE CIR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6234
Mailing Address - Country:US
Mailing Address - Phone:909-621-2201
Mailing Address - Fax:909-621-2206
Practice Address - Street 1:9509 CENTRAL AVE
Practice Address - Street 2:UNIT D
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763
Practice Address - Country:US
Practice Address - Phone:909-621-2201
Practice Address - Fax:909-621-2206
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54321122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist