Provider Demographics
NPI:1730320250
Name:FARHIDPOUR, FARNAZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARNAZ
Middle Name:
Last Name:FARHIDPOUR
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 1:13768 ROSWELL AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1401
Mailing Address - Country:US
Mailing Address - Phone:909-902-1212
Mailing Address - Fax:909-902-1213
Practice Address - Street 1:13768 ROSWELL AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1401
Practice Address - Country:US
Practice Address - Phone:909-902-1212
Practice Address - Fax:909-902-1213
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist