Provider Demographics
NPI:1639373400
Name:FARHOUMAND, MAHSHID (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAHSHID
Middle Name:
Last Name:FARHOUMAND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23024 LAKE FOREST DR STE A
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1328
Mailing Address - Country:US
Mailing Address - Phone:949-716-7166
Mailing Address - Fax:
Practice Address - Street 1:23024 LAKE FOREST DR STE A
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1328
Practice Address - Country:US
Practice Address - Phone:949-716-7166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44168122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist