Provider Demographics
NPI:1912016072
Name:KALANTARI, FARIBA (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARIBA
Middle Name:
Last Name:KALANTARI
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 1:1777 VINE ST
Mailing Address - Street 2:404
Mailing Address - City:HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90028-5255
Mailing Address - Country:US
Mailing Address - Phone:323-461-4676
Mailing Address - Fax:323-461-3664
Practice Address - Street 1:1777 VINE ST
Practice Address - Street 2:404
Practice Address - City:HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90028-5255
Practice Address - Country:US
Practice Address - Phone:323-461-4676
Practice Address - Fax:323-461-3664
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA514261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice