Provider Demographics
NPI:1821057415
Name:MOFTAKHAR, FARSHAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARSHAD
Middle Name:
Last Name:MOFTAKHAR
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 1:1630 CARLA RDG
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-1910
Mailing Address - Country:US
Mailing Address - Phone:310-274-7485
Mailing Address - Fax:626-363-6448
Practice Address - Street 1:9025 WILSHIRE BLVD
Practice Address - Street 2:STE315
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1831
Practice Address - Country:US
Practice Address - Phone:310-274-7485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice