Provider Demographics
NPI:1750848776
Name:MASTOUR & FARD DENTAL CORP
Entity Type:Organization
Organization Name:MASTOUR & FARD DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:SABBAGH FARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-499-1253
Mailing Address - Street 1:587 N VENTU PARK RD STE C
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2743
Mailing Address - Country:US
Mailing Address - Phone:805-499-1253
Mailing Address - Fax:
Practice Address - Street 1:587 N VENTU PARK RD STE C
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-2743
Practice Address - Country:US
Practice Address - Phone:805-499-1253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery