Provider Demographics
NPI:1891814687
Name:ASSIL, FARIBA (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARIBA
Middle Name:
Last Name:ASSIL
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 1:7136 PACIFIC BLVD
Mailing Address - Street 2:210
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4783
Mailing Address - Country:US
Mailing Address - Phone:323-585-1000
Mailing Address - Fax:323-585-5391
Practice Address - Street 1:7136 PACIFIC BLVD
Practice Address - Street 2:210
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4783
Practice Address - Country:US
Practice Address - Phone:323-585-1000
Practice Address - Fax:323-585-5391
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32530122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist