Provider Demographics
NPI:1639357783
Name:FARHAD DAFTARY DMD INC
Entity Type:Organization
Organization Name:FARHAD DAFTARY DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FARHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAFTARY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:805-485-6416
Mailing Address - Street 1:2001 SOLAR DR
Mailing Address - Street 2:225
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0638
Mailing Address - Country:US
Mailing Address - Phone:805-485-6416
Mailing Address - Fax:805-983-7766
Practice Address - Street 1:2001 SOLAR DR
Practice Address - Street 2:225
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0638
Practice Address - Country:US
Practice Address - Phone:805-485-6416
Practice Address - Fax:805-983-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320531223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty