Provider Demographics
NPI:1639279268
Name:FARID, FARNAZ (DMD)
Entity Type:Individual
Prefix:DR
First Name:FARNAZ
Middle Name:
Last Name:FARID
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 VILLA LA JOLLA DR STE B101
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1705
Mailing Address - Country:US
Mailing Address - Phone:858-200-5967
Mailing Address - Fax:858-886-7251
Practice Address - Street 1:8950 VILLA LA JOLLA DR STE B101
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1705
Practice Address - Country:US
Practice Address - Phone:858-550-8000
Practice Address - Fax:858-200-5967
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52552122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist