Provider Demographics
NPI:1841570736
Name:TABRIZI, FARNAZ T (DDS)
Entity Type:Individual
Prefix:
First Name:FARNAZ
Middle Name:T
Last Name:TABRIZI
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 1:2030 DOUGLAS BLVD STE 37
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3857
Mailing Address - Country:US
Mailing Address - Phone:916-773-6222
Mailing Address - Fax:916-773-5666
Practice Address - Street 1:2030 DOUGLAS BLVD STE 37
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3857
Practice Address - Country:US
Practice Address - Phone:916-773-6222
Practice Address - Fax:916-773-5666
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist