Provider Demographics
NPI:1770856247
Name:DAFTARY, FEREIDOUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:FEREIDOUN
Middle Name:
Last Name:DAFTARY
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 1:9001 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1838
Mailing Address - Country:US
Mailing Address - Phone:310-285-0530
Mailing Address - Fax:310-285-0534
Practice Address - Street 1:9001 WILSHIRE BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1838
Practice Address - Country:US
Practice Address - Phone:310-285-0530
Practice Address - Fax:310-285-0534
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301891223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics