Provider Demographics
NPI:1750462412
Name:FARD, OMID ANBIAI (DDS)
Entity Type:Individual
Prefix:
First Name:OMID
Middle Name:ANBIAI
Last Name:FARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-5779
Mailing Address - Country:US
Mailing Address - Phone:925-679-9999
Mailing Address - Fax:925-679-9996
Practice Address - Street 1:3631 MAIN ST
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-5779
Practice Address - Country:US
Practice Address - Phone:925-679-9999
Practice Address - Fax:925-679-9996
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA421101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice