Provider Demographics
NPI:1699821017
Name:FARR, EVAN AFSHIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:AFSHIN
Last Name:FARR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:AFSHIN
Other - Middle Name:EIVAN
Other - Last Name:AGHAEIFAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:12115 SATICOY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-3025
Mailing Address - Country:US
Mailing Address - Phone:818-521-4049
Mailing Address - Fax:
Practice Address - Street 1:12115 SATICOY ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-3025
Practice Address - Country:US
Practice Address - Phone:818-521-4049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49261122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist